侧卧位DAA下生物型短柄与标准柄THA治疗股骨头坏死的临床研究

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Abstract Objective To compare the clinical efficacy of biological short stem and standard stem in total hip arthroplasty(THA)through direct anterior approach(DAA)in lateral decubitus position in the treatment of osteonecrosis of the femoral head(ONFH).Methods A total of 145 hips were enrolled in a retrospective analysis of patients with ONFH admitted to Ward of Osteonecrosis and Joint Reconstruction of Honghui Hospital from January 2019 to March 2021.There were 69 hips(34 males and 35 females，aged 59.16±8.86 years) in the short stem group and 76 hips(35 males and 41 females，aged 58.28±8.59 years) in the standard stem group according to the type of femoral stem prosthesis.Perioperative indexes，including operative time，incision length and intraoperative blood loss were compared between the two groups.Visual analogue score(VAS) of pain before surgery and 1，3，7 days after surgery，Harris score of hip joint before surgery and 1，3，6 months after surgery and the last followup were recorded.Preoperative and postoperative Xray films were used to measure hip eccentricity，implant subsidence and varus migration.Results There were no significant differences in operative time and incision length between the two groups(P＞0.05).The amount of intraoperative blood loss in the short stalk group was less than that in the standard stalk group(P＜0.05).There was no significant difference in preoperative and postoperative VAS between two groups(P＞0.05).Preoperative Harris hip score was not significantly different between the two groups(P＞0.05)，there was significant difference between 1 and 3 months after operation(P＜0.05)，and there was no significant difference in the scores at 6 months after operation and at the last follow-up(P＞0.05).Follow-up imaging measurements 12 months after surgery showed that 2 patients in the short stem group had prosthesis migration >3 °.The deviation angle of the standard stem group was less than 3°.There were 3 cases of prosthesis sinking more than 3 mm in short stem group.Standard stem group prosthesis sinking was less than 3 mm.The difference of bilateral eccentricity was less than 4 mm between the two groups.Conclusion Compared with the standard handle，the short stem hip prosthesis has more advantages in THA treatment of ONFH with DDA approach，which can reduce the difficulty of intraoperative treatment of femoral side，shorten the operation time，reduce intraoperative bleeding，and achieve higher postoperative satisfaction.

Key words： osteonecrosis of the femoral head direct anterior approach total hip arthroplasty short stem prosthesis

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[1]	. [J]. sygkzz, 2022, 28(5): 449-451.