摘要
目的 探讨髋臼螺钉在非骨水泥全髋置换术中对髋臼假体稳定性的影响。方法 回顾性分析2009年8月至2015年8月在深圳市龙岗区人民医院骨科行非骨水泥全髋置换术114例(117髋)病例资料,患者根据术中是否植入髋臼螺钉分成两组,其中A组无螺钉组59髋,B组螺钉固定组58髋。分别在术后3个月、12个月、24个月和末次随访时对病人进行随访,评估并比较影像学的改变及Harris评分。A组57髋B组56髋获得完整随访资料,平均随访(5.7±1.6)年。以 Kaplan-Meier 法分析两组假体生存率。结果 A组平均手术时间( t =2.213, P <0.05)、术中出血量均小于B组( t =2.342, P <0.05);随访末期,A、B组术后平均Harris评分为(95.0±2.1)分及(93.0±5.5)分( P >0.05);A、B组术后3个月、12个月、24个月分别有4髋(7.0%)、3髋(5.3%)、1髋(1.8%)和1髋(1.8%)、2髋(3.6%)及2髋(3.6%)出现髋臼周围透亮线;A组1髋术后4年出现骨溶解,B组2髋出现骨溶解。以影像学证明假体松动作为失败标准,计算两组假体平均随访(5.7±1.6)年生存率分别为97%和95%,两者差异无统计学意义( P >0.05)。结论髋臼骨质条件良好时是否使用髋臼螺钉固定对臼杯的稳定性无明显影响,全髋关节置换术中植入髋臼螺钉不是必需的。
Objective To investigate the clinical and radiographic outcomes of uncemented total hip arthroplasty with and without screw fixation.Methods A retrospective analysis of 114 patients(117 hips) with cementless total hip arthroplasty performed from August 2009 to August 2015 was carried out.The patients were randomized into group A without adjunctive screw fixation ( n =59) and group B with screw fixation ( n =58).Consecutive radiographs were compared to evaluate acetabular stability at the 3 rd month,12 th month,24 th month postoperatively and at the last follow-up.Harris hip scores and radiological outcomes were analyzed.Fifty-seven hips in group A and 56 hips in group B were available for complete clinical and radiographic analysis.The Kaplan-Meier survivorship analysis was used to estimate the survival of the prothesis in the two groups.Results The mean follow-up period was (5.7±1.6) years.The mean surgery duration and operative bleeding was less in group A than in group B( t =2.213,P<0.05,t =2.342,P<0.05 respectively).At the last follow-up,the Harris scores were (95.0±2.1) in group A and (93.0±5.5) in group B ( P =0.693).Radiolucent lines were seen in four hips(7.0%),three hips(5.3%),one hip(1.8%)in group A and one hip(1.8%),two hips(3.6%),two hips(3.6%)in group B at the 3 rd month,12 th month and 24 th month after surgery respectively.Osteolysis and migration were found in one hip in group A and 2 hips in group B.Kaplan-Meier survivorship at mean (5.7±1.6) years follow-up was 97% in group A and 95% in group B with radiographic loosening as the end point( P >0.05).Conclusion Additional screw fixation in principle is not necessary in press-fit cups,especially when there is no acetabular bone defect.
作者
李朋
唐向阳
吴同岭
于志滨
朱智奇
Li Peng;Tang Xiangyang;Wu Tonglin;Yu Zhibin;Zhu Zhiqi(Department of Orthopedic,Longgang district people’s hospital of Shenzhen,Shenzhen 518172,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2019年第3期284-289,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
骨螺丝
髋臼
关节成形术
假体安装
Bone screws
Acetabulum
Arthroplasty
Prosthesis fitting
