两种股骨柄假体对全髋关节置换术围手术期影响

doi:10.3877/cma.j.issn.1674-134X.2025.03.003

目的

观察Tri-lock骨保留型股骨柄（BPS）与Corail股骨柄假体对全髋关节置换术（THA）患者围术期指标、关节功能评分和术后并发症的影响。

方法

选择髋臼发育不良且首次行THA治疗的243例患者，排除有髋关节手术史、美国麻醉医师协会（ASA）分级≥Ⅲ级、骨密度T值<-5及合并其他严重疾病的患者。按照不同股骨柄假体分为Corail组123例（167髋）和Tri-lock BPS组120例（151髋）。使用t经验及卡方检验比较两组围术期指标、关节功能、股骨柄初始稳定性、影像学指标、步态参数及术后并发症。

结果

Tri-lock BPS组的患者出血量少于Corail组，术后住院时间较Corail组显著变短（t=3.148，P<0.05）；两组患者术后1、3、6、12个月的Harris评分时间效应有统计学意义（F=1295.358，P<0.05）；Tri-lock BPS组股骨偏心距（offset）、股骨小转子最宽部骨量保留面积、大小转子间骨量保留体积较Corail组显著变高（t=9.701、4.941、46.493，均为P<0.05）。Tri-lock BPS组步幅、步长较Corail组显著变大（t=4.113、5.083，均为P<0.05），步频、步态不对称指数较Corail组显著变小（t=3.458、4.911，均为P<0.05）。Tri-lock BPS组术后并发症发生率低于对照组（χ²=4.074，P<0.05）。

结论

Tri-Lock BPS股骨柄在THA中可减少出血量，缩短住院时间，提高Offset值，保留更多的股骨小转子最宽部骨量、大小转子间骨量，改善步态，并降低术后并发症风险。

关键词: 关节成形术，置换，髋, 髋假体, 围手术期, 步态, 术后并发症

Objective

To observe the effects of Tri-Lock bone preservation stem (BPS) and Corail femoral stem prosthesis on perioperative indicators, joint function scores and postoperative complications in patients undergoing total hip arthroplasty (THA).

Methods

A total of 243 patients with developmental dysplasia of the hip who underwent primary THA in the First People’s Hospital of Guangyuan were enrolled, while the patients with hip surgical history, American Society of Anesthesiologists (ASA) classification ≥Ⅲ, bone density T value <-5 and other severe diseases were excluded. The patients were assigned to the Corail group (123 cases, 167 hips) and the Tri-Lock BPS group (120 cases, 151 hips) according to different femoral stem prostheses used. T test and chi-squared test were performed to compare perioperative indicators, joint function, initial stability of femoral stem, imaging parameters, gait parameter and postoperative complications between the two groups.

Results

Blood loss of the Tri-Lock BPS group was less than that of the Corail group, and length of postoperative hospital stay was significantly shorter than that of the Corail group (t=3.148, P<0.05). Harris scores of the two groups at one, three, six and twelve months after surgery showed statistically significant differences in terms of time effect (F=1295.358, P<0.05). The femur offset, bone mass retention area of the widest part of the lesser trochanter and bone mass retention volume between the greater and lesser trochanters in the Tri-Lock BPS group were larger than those in the Corail group (t=9.701, 4.941, 46.493, all P<0.05). The stride length and step length of Tri-lock BPS group were significantly larger than that of Corail group (t=4.113, 5.083, both P<0.05). The stride frequency and gait asymmetry index were significantly smaller than that of Corail group (t=3.458, 4.911, both P<0.05). The postoperative complication rate in the Tri-Lock BPS group was lower than that in the Corail group (χ²=4.074, P<0.05).

Conclusion

Applying Tri-Lock BPS femoral stem in THA can reduce blood loss, shorten the length of hospital stay, increase offset value, retain more bone mass in the broadest part of the lesser trochanter and the intertrochanteric bone mass, improve gait, and reduce postoperative complication risk.

Key words: Arthroplasty, replacement, hip, Hip prosthesis, Perioperative period, Gait, Postoperative complications

表1 两组患者一般资料比较

Table 1 Comparison of general data between the two groups

组别Groups	例数Number of cases	性别[例（%）]Gender		年龄[岁，（±s）]Age (year)	BMI [kg/m²，（±s）]	骨质疏松[例（%）]Osteoporosis	骨密度T值（±s）T value of bone density
组别Groups	例数Number of cases	男Male	女Female	年龄[岁，（±s）]Age (year)	BMI [kg/m²，（±s）]	骨质疏松[例（%）]Osteoporosis	骨密度T值（±s）T value of bone density
Tri-lock BPS组Tri-lock BPS group	120	39（32.5）	81（67.5）	58.9±5.5	21.3±1.3	81（67.5）	-3.0±1.4
Corail组Corail group	123	36（29.3）	87（70.7）	57.9±6.0	21.2±1.3	78（63.4）	-2.0±1.4
统计值Statistical values		χ²=0.297		t=1.307	t=1.083	χ²=0.448	t=0.166
P值		>0.05		>0.05	>0.05	>0.05	>0.05

表1 两组患者一般资料比较

Table 1 Comparison of general data between the two groups

组别Groups	例数Number of cases	性别[例（%）]Gender		年龄[岁，（±s）]Age (year)	BMI [kg/m²，（±s）]	骨质疏松[例（%）]Osteoporosis	骨密度T值（±s）T value of bone density
组别Groups	例数Number of cases	男Male	女Female	年龄[岁，（±s）]Age (year)	BMI [kg/m²，（±s）]	骨质疏松[例（%）]Osteoporosis	骨密度T值（±s）T value of bone density
Tri-lock BPS组Tri-lock BPS group	120	39（32.5）	81（67.5）	58.9±5.5	21.3±1.3	81（67.5）	-3.0±1.4
Corail组Corail group	123	36（29.3）	87（70.7）	57.9±6.0	21.2±1.3	78（63.4）	-2.0±1.4
统计值Statistical values		χ²=0.297		t=1.307	t=1.083	χ²=0.448	t=0.166
P值		>0.05		>0.05	>0.05	>0.05	>0.05

表2 两组患者围术期指标比较（

±s）

Table 2 Comparison of perioperative indicators between the two groups

组别Groups	例数Number of cases	手术时间Duration of surgery (min)	术中出血量Intraoperative blood loss (ml)	术前HB Preoperative HB level (g/L)	手术前后HB改变量Changes in HB before and after surgery (g/L)	术后住院时间Postoperative length of hospital stay (d)
Tri-lock BPS组Tri-lock BPS group	120	75.6±10.5	184.3±46.3	131.5±18.4	17.0±9.6	6.1±1.5
Corail组Corail group	123	76.1±9.5	201.3±45.8	129.0±23.2	18.5±8.6	6.7±1.5
t值		0.398	2.890	0.944	1.226	3.148
P值		>0.05	0.004	>0.05	>0.05	0.002

表2 两组患者围术期指标比较（

±s）

Table 2 Comparison of perioperative indicators between the two groups

组别Groups	例数Number of cases	手术时间Duration of surgery (min)	术中出血量Intraoperative blood loss (ml)	术前HB Preoperative HB level (g/L)	手术前后HB改变量Changes in HB before and after surgery (g/L)	术后住院时间Postoperative length of hospital stay (d)
Tri-lock BPS组Tri-lock BPS group	120	75.6±10.5	184.3±46.3	131.5±18.4	17.0±9.6	6.1±1.5
Corail组Corail group	123	76.1±9.5	201.3±45.8	129.0±23.2	18.5±8.6	6.7±1.5
t值		0.398	2.890	0.944	1.226	3.148
P值		>0.05	0.004	>0.05	>0.05	0.002

表3 两组患者Harris评分比较（

±s）

Table 3 Comparison of Harris scores between the two groups

组别Groups	例数Number of cases	术前Before surgery	术后1个月One month after surgery	术后3个月Three months after surgery	术后6个月Six months after surgery	术后12个月Twelve months after surgery
Tri-lock BPS组Tri-lock BPS group	120	48±6	68±6^a	78±4^ab	83±4^abc	85±5^abcd
Corail组Corail group	123	47±5	67±7^a	78±4^ab	82±5^abc	84±5^abd
t值		时间Time：1295.358；组间Inter-group：2.384；交互Interaction：1.697
P值		时间Time：<0.001；组间Inter-group：>0.05；交互Interaction：>0.05

表3 两组患者Harris评分比较（

±s）

Table 3 Comparison of Harris scores between the two groups

组别Groups	例数Number of cases	术前Before surgery	术后1个月One month after surgery	术后3个月Three months after surgery	术后6个月Six months after surgery	术后12个月Twelve months after surgery
Tri-lock BPS组Tri-lock BPS group	120	48±6	68±6^a	78±4^ab	83±4^abc	85±5^abcd
Corail组Corail group	123	47±5	67±7^a	78±4^ab	82±5^abc	84±5^abd
t值		时间Time：1295.358；组间Inter-group：2.384；交互Interaction：1.697
P值		时间Time：<0.001；组间Inter-group：>0.05；交互Interaction：>0.05

表4 两组股骨柄初始稳定性比较[例(%)]

Table 4 Comparison of initial stability of femoral stem between the two groups

组别Groups	髋数Number of hips	优Excellent	良Good	差Poor	优良Excellent and good
Tri-lock BPS组Tri-lock BPS group	151	129（85.4）	18（11.9）	4（2.7）	147（97.3）
Corail组Corail group	167	136（81.4）	28（16.8）	3（1.8）	163（97.6）
χ²值					0.021
P值					>0.05

表4 两组股骨柄初始稳定性比较[例(%)]

Table 4 Comparison of initial stability of femoral stem between the two groups

组别Groups	髋数Number of hips	优Excellent	良Good	差Poor	优良Excellent and good
Tri-lock BPS组Tri-lock BPS group	151	129（85.4）	18（11.9）	4（2.7）	147（97.3）
Corail组Corail group	167	136（81.4）	28（16.8）	3（1.8）	163（97.6）
χ²值					0.021
P值					>0.05

表5 两组患者影像学资料比较（

±s）

Table 5 Comparison of imaging data between the two groups

组别Groups	髋数Number of hips	双下肢绝对长度差(cm) Length differences of bilateral lower limbs		股骨小转子最宽部骨量保留面积（cm²）Bone mass retention of the largest part of the lesser trochanter	偏心距(mm)Offset		大小转子间骨量保留体积（cm²）Bone mass retention between the greater and lesser trochanters
组别Groups	髋数Number of hips	术前Before surgery	术后12个月Twelve months after surgery		术前Before surgery	术后12个月Twelve months after surgery
Tri-lock BPS组Tri-lock BPS group	151	1.78±0.42	0.98±0.30^a	6.04±0.41	37.15±3.41	47.23±3.16^a	25.35±1.62^a
Corail组Corail group	167	1.73±0.56	1.02±0.27^a	5.86±0.22	37.64±3.23	43.85±3.05^a	16.67±1.70^a
t值		0.893	1.251	4.941	1.316	9.701	46.493
P值		>0.05	>0.05	<0.001	>0.05	<0.001	<0.001

表5 两组患者影像学资料比较（

±s）

Table 5 Comparison of imaging data between the two groups

组别Groups	髋数Number of hips	双下肢绝对长度差(cm) Length differences of bilateral lower limbs		股骨小转子最宽部骨量保留面积（cm²）Bone mass retention of the largest part of the lesser trochanter	偏心距(mm)Offset		大小转子间骨量保留体积（cm²）Bone mass retention between the greater and lesser trochanters
组别Groups	髋数Number of hips	术前Before surgery	术后12个月Twelve months after surgery		术前Before surgery	术后12个月Twelve months after surgery
Tri-lock BPS组Tri-lock BPS group	151	1.78±0.42	0.98±0.30^a	6.04±0.41	37.15±3.41	47.23±3.16^a	25.35±1.62^a
Corail组Corail group	167	1.73±0.56	1.02±0.27^a	5.86±0.22	37.64±3.23	43.85±3.05^a	16.67±1.70^a
t值		0.893	1.251	4.941	1.316	9.701	46.493
P值		>0.05	>0.05	<0.001	>0.05	<0.001	<0.001

表6 两组患者步态参数比较（

±s）

Table 6 Comparison of gait parameters between two groups

组别Groups	例数Number of cases	步幅Stride （m）		步长Stride length （m）
组别Groups	例数Number of cases	术前Before surgery	术后12个月Twelve months after surgery	术前Before surgery	术后12个月Twelve months after surgery
Tri-lock BPS组Tri-lock BPS group	120	0.480±0.120	0.800±0.130	0.320±0.100	0.470±0.060
Corail组Corail group	123	0.490±0.130	0.720±0.170	0.330±0.110	0.420±0.090
t值		0.623	4.113	0.741	5.083
P值		>0.05	<0.001	>0.05	<0.001
组别Groups	例数Number of cases	步频（步/min）Stride frequency (steps/min)		步态不对称指数Gait asymmetry index
组别Groups	例数Number of cases	术前Before surgery	术后12个月Twelve months after surgery	术前Before surgery	术后12个月Twelve months after surgery
Tri-lock BPS组Tri-lock BPS group	120	125.610±11.230	88.630±8.260	0.240±0.070	0.110±0.020
Corail组Corail group	123	126.490±10.380	92.490±9.110	0.250±0.080	0.130±0.040
t值		0.635	3.458	1.036	4.911
P值		>0.05	0.001	>0.05	<0.001

表6 两组患者步态参数比较（

±s）

Table 6 Comparison of gait parameters between two groups

组别Groups	例数Number of cases	步幅Stride （m）		步长Stride length （m）
组别Groups	例数Number of cases	术前Before surgery	术后12个月Twelve months after surgery	术前Before surgery	术后12个月Twelve months after surgery
Tri-lock BPS组Tri-lock BPS group	120	0.480±0.120	0.800±0.130	0.320±0.100	0.470±0.060
Corail组Corail group	123	0.490±0.130	0.720±0.170	0.330±0.110	0.420±0.090
t值		0.623	4.113	0.741	5.083
P值		>0.05	<0.001	>0.05	<0.001
组别Groups	例数Number of cases	步频（步/min）Stride frequency (steps/min)		步态不对称指数Gait asymmetry index
组别Groups	例数Number of cases	术前Before surgery	术后12个月Twelve months after surgery	术前Before surgery	术后12个月Twelve months after surgery
Tri-lock BPS组Tri-lock BPS group	120	125.610±11.230	88.630±8.260	0.240±0.070	0.110±0.020
Corail组Corail group	123	126.490±10.380	92.490±9.110	0.250±0.080	0.130±0.040
t值		0.635	3.458	1.036	4.911
P值		>0.05	0.001	>0.05	<0.001

表7 两组患者术后并发症的比较[例（%）]

Table 7 Comparison of postoperative complications between the two groups

组别Groups	例数Number of cases	术后脱位Postoperative dislocation	术后骨折Postoperative fracture	大腿远端疼痛Pain in the distal thigh	大腿近端疼痛Pain in the proximal thigh	总发生率Total incidence
Tri-lock BPS组Tri-lock BPS group	120	0	0	2（1.7）	2（1.7）	4（3.3）
Corail组Corail group	123	1（0.8）	1（0.8）	6（4.9）	4（3.3）	12（9.8）
χ²值						4.074
P值						0.044

表7 两组患者术后并发症的比较[例（%）]

Table 7 Comparison of postoperative complications between the two groups

组别Groups	例数Number of cases	术后脱位Postoperative dislocation	术后骨折Postoperative fracture	大腿远端疼痛Pain in the distal thigh	大腿近端疼痛Pain in the proximal thigh	总发生率Total incidence
Tri-lock BPS组Tri-lock BPS group	120	0	0	2（1.7）	2（1.7）	4（3.3）
Corail组Corail group	123	1（0.8）	1（0.8）	6（4.9）	4（3.3）	12（9.8）
χ²值						4.074
P值						0.044

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Effects of two kinds of femoral stem prostheses on perioperative period of total hip arthroplasty

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Effects of two kinds of femoral stem prostheses on perioperative period of total hip arthroplasty