髋臼螺钉对非骨水泥全髋置换术中假体稳定性的影响

doi:10.3877/cma.j.issn.1674-134X.2019.03.005

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。

关键词: 骨螺丝, 髋臼, 关节成形术, 假体安装

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.

Key words: Bone screws, Acetabulum, Arthroplasty, Prosthesis fitting

图1 髋关节置换术后骨盆X线正位片。L1为泪滴间连线，L2为泪滴垂线，d1为髋臼中心至泪滴连线的垂直距离，d2为髋臼中心至泪滴垂线的垂直距离。d1、d2变化大于5 mm被视为不稳定。

图3 髋关节置换术后左髋关节X线正位片。图A　为术后1周，示臼杯位置良好；图B　为术后2.8年，示髋臼骨溶解伴臼杯明显移位，发生感染性松动；图C　为用髋臼加强环行翻修术后1年

表1 两组病人影像学随访结果对比

组别	例数	透亮线发生率
组别	例数	术后3个月	术后12个月	术后24个月
A组	57	4(7.0%)	3(5.3%)	1(1.8%)
B组	56	1(1.8%)	2(3.6%)	2(3.6%)
χ²值	?	1.828	0.191	0.361
P值	?	>0.05	>0.05	>0.05

表1 两组病人影像学随访结果对比

组别	例数	透亮线发生率
组别	例数	术后3个月	术后12个月	术后24个月
A组	57	4(7.0%)	3(5.3%)	1(1.8%)
B组	56	1(1.8%)	2(3.6%)	2(3.6%)
χ²值	?	1.828	0.191	0.361
P值	?	>0.05	>0.05	>0.05

图4 左侧髋关节置换前后X线正位片。图A　为术前髋关节正位片，示左股骨头无菌性坏死；图B　为术后1周，示已行全髋置

图5 左侧髋关节置换前后X线正位片。图A　为术前髋关节正位片，示左股骨颈骨折；图B　为术后1周左髋关节，示已行全髋关节置换，使用螺钉固定；图C　和图D　分别为术后6个月和术后3.6年，示假体稳定性良好

图6 Kaplan-Meier生存分析曲线，A、B组术后平均随访5.7年假体生存率分别为97%和95%，两组差异无统计学意义(χ²＝0.609，P>0.05)

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Effects of uncemented total hip arthroplasty with and without screw fixation on prosthesis stability

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Effects of uncemented total hip arthroplasty with and without screw fixation on prosthesis stability