迟方舟;王文波;

• 1:哈尔滨医科大学附属第一医院骨三科

摘要(Abstract)：

髋关节置换术(total hip arthroplasty, THA)是骨科手术中最常见、最成功的手术之一,股骨颈骨折是髋关节置换术主要适应证。在临床应用中传统的非骨水泥股骨假体存在较高股骨骨折和塌陷的风险并增加了翻修的可能性,同时还存在近端-远端错配、非理想负荷转移、骨丢失、大腿疼痛和假体周围骨折等缺陷。在近二十年以来,髋关节置换术经历了一个不断发展的过程,短柄假体逐渐替代传统的非骨水泥股骨假体,并且具有一系列优点:保留骨量(高颈骨切除),保留股骨颈的解剖前倾,减少皮质应力,减少残余大腿疼痛,延长假体的使用寿命,更适用于微创手术等。目前,关于非骨水泥股骨短柄假体于股骨颈骨折的应用并无相关指南,更多依靠临床医生的经验。本文将从术中情况及术后并发症的多个角度阐述非骨水泥股骨短柄假体的优势及其应用现状。

关键词(KeyWords)： 全髋关节置换术;非骨水泥股骨短柄假体;股骨颈骨折

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 迟方舟;王文波;

Email:

DOI:

参考文献(References)：

• [1] Jahnke A, Fonseca Ulloa CA, Seeger JB, et al. Analysis of the elastic bending characteristics of cementless short hip stems considering the valgus alignment of the prosthetic stem[J]. Clin Biomech(Bristol, Avon), 2018, 52(1):49-56.
• [2] Falez F, Casella F, Papalia M. Current concepts, classification, and results in short stem hip arthroplasty[J]. Orthopedics, 2015, 38(3Suppl):6-13.
• [3] Pairon P, Haddad FS. Stem size in hip arthroplasty:could shorter be better and when will we know[J]. Bone Joint J, 2018, 100-b(9):1133-1135.
• [4] Malhotra R, Kumar V. Mid-term outcome of total hip arthroplasty using a short stem[J]. J Orthop Surg(Hong Kong), 2016, 24(3):323-327.
• [5] Loppini M, Grappiolo G. Uncemented short stems in primary total hip arthroplasty:the state of the art[J]. Efort Open Rev, 2018, 3(5):149-159.
• [6] Gkagkalis G, Goetti P, Mai S, et al. Cementless short-stem total hip arthroplasty in the elderly patient-is it a safe option? A prospective multicentre observational study[J]. BMC Geriatr, 2019,19(1):112.
• [7] Hochreiter J, Hejkrlik W, Emmanuel K, et al. Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study[J].Int Orthop, 2017, 41(7):1347-1353.
• [8] Yu H, Liu H, Jia M, et al. A comparison of a short versus a conventional femoral cementless stem in total hip arthroplasty in patients70 years and older[J]. J Orthop Surg Res, 2016, 11(1):33.
• [9] Kaufmann KB, Baar W, Rexer J, et al. Evaluation of hemodynamic goal-directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty-a randomized parallel-arm trial[J]. BMC Anesthesiol,2018, 18(1):63.
• [10] Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients[J].Bone Joint J, 2016, 98-b(3):291-297.
• [11] Barenius B, Inngul C, Alagic Z, et al. A randomized controlled trial of cemented versus cementless arthroplasty in patients with a displaced femoral neck fracture:a four-year follow-up[J]. Bone Joint J, 2018, 100-b(8):1087-1093.
• [12] Patil S, Luis C, Finn H. Porous femoral fixation in total hip arthroplasty with short anatomical stem:radiographic evaluation[J].Clin Orthop Surg, 2017, 9(3):255-262.
• [13] Liang HD, Yang WY, Pan JK, et al. Are short-stem prostheses superior to conventional stem prostheses in primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials[J]. BMJ Open, 2018, 8(9):e021649.
• [14] Huo SC, Wang F, Dong LJ, et al. Short-stem prostheses in primary total hip arthroplasty:a meta-analysis of randomized controlled trials[J]. Medicine(Baltimore), 2016, 95(43):e5215.
• [15] Yan SG, Weber P, Steinbruck A, et al. Periprosthetic bone remodelling of short-stem total hip arthroplasty:a systematic review[J].Int Orthop, 2018, 42(9):2077-2086.
• [16] Lee SJ, Yoon KS. Favorable functional recovery and stem stability after hip arthroplasty with a short metaphyseal stem in elderly patients with osteoporotic femoral neck fractures[J]. Hip Pelvis,2019, 31(1):11-17.
• [17] Kim YH, Oh JH. A comparison of a conventional versus a short, anatomical metaphyseal-fitting cementless femoral stem in the treatment of patients with a fracture of the femoral neck[J]. J Bone Joint Surg Br, 2012, 94(6):774-781.
• [18] Capone A, Bienati F, Torchia S, et al. Short stem total hip arthroplasty for osteonecrosis of the femoral head in patients 60 years or younger:a 3-to 10-year follow-up study[J]. BMC Musculoskelet Disord, 2017, 18(1):301.
• [19] Veldman HD, Heyligers IC, Grimm B, et al. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck:a systematic review and meta-analysis of current generation hip stems[J]. Bone Joint J, 2017, 99-b(4):421-431.
• [20] Wiik AV, Brevadt M, Johal H, et al. The loading patterns of a short femoral stem in total hip arthroplasty:gait analysis at increasing walking speeds and inclines[J]. J Orthop Traumatol, 2018, 19(1):14.
• [21] Schilcher J, Ivarsson I, Perlbach R, et al. No Difference in periprosthetic bone loss and fixation between a standard-length stem and a shorter version in cementless total hip arthroplasty. A randomized controlled Trial[J]. J Arthroplasty, 2017, 32(4):1220-1226.
• [22] Fischer M, Beckmann NA, Simank HG. Bone remodelling around the metha((R))short stem implant-Clinical and dual-energy Xray absorptiometry(DXA)results[J]. J Orthop, 2017, 14(4):525-529.
• [23] van Oldenrijk J, Molleman J, Klaver M, et al. Revision rate after short-stem total hip arthroplasty:a systematic review of 49 studies[J]. Acta Orthop, 2014, 85(3):250-258.
• [24] Yan SG, Li D, Yin S, et al. Periprosthetic bone remodeling of short cementless femoral stems in primary total hip arthroplasty:a systematic review and meta-analysis of randomized-controlled trials[J]. Medicine(Baltimore), 2017, 96(47):e8806.
• [25] Cook GE, Samiezadeh S, Morison Z, et al. Biomechanical optimization of the angle and position for surgical implantation of a straight short stem hip implant[J]. Med Eng Phys, 2017, 39:23-30.
• [26] Jones C, Aqil A, Clarke S, et al. Short uncemented stems allow greater femoral flexibility and may reduce peri-prosthetic fracture risk:a dry bone and cadaveric study[J]. J Orthop Traumatol,2015, 16(3):229-235.