| Objective:The sex ratio,age distribution,causes and morphological distribution of femoral bone marrow cavity in a group of patients with unusually large Dorr type C femoral bone marrow cavity were retrospectively analyzed.Dorr C medullary cavity line hip replacement for the first time choose Wagner SL creature type femoral prosthesis handle,study the femoral prosthesis handle and medullary cavity filling rate and matching,by Harris function score before and after hip surgery compared hip joint function recovery time and the recent situation and implant bone ingrowth prosthesis handle loose during the follow-up period,sinking,and so on and so forth;To study the reliability and clinical efficacy of Wagner SL biological femoral stem prosthesis in patients with Dorr type C medullary cavity during the first hip arthroplasty,so as to provide a clinical reference for joint surgeons in the selection of femoral stem prosthesis and treatment plan.Methods:Retrospective analysis was made on the clinical data of 90 patients with 94 hip Dorr C type femur "chimney-shaped" abnormal thick medullary cavity in the 940 hospital of the PLA joint logistics support force(former lanzhou military region general hospital)from January2009 to December 2011 who underwent primary artificial hip replacement using Wagner SL biological femoral stem prosthesis.The sex ratio,age distribution,primary etiology,femoral bone marrow cavity size and morphological distribution were analyzed.Determined by preoperative X-ray femoral medullary cavity form at the near end are Dorr C type,and postoperative radiographic analysis including immediate postoperative X-ray examination,by measuring the position of the femoral prosthesis handle in the medullary cavity and filling rate to judge the prosthesis with abnormal matching of bulky pulp cavity,X ray film about recent follow-up bone-implant interface bone ingrowth and femoral prosthesis handle loose at the time of the last follow-up,sinking and complications,such as heterotopic ossification with Harris,postoperative function recovery of hip function score evaluation.Results:1.General conditions of the operation: including the operation time,intraoperative bloodloss,postoperative drainage,and the time to go to the ground(1)In this group,the operative time was 60 ~ 160 min,with an average of(100.7±8.3)min.Intraoperative blood loss was 50 ~ 900 ml(mean 239.2±20.6 ml).Postoperative drainage volume was 20 ~ 500 ml,with an average of(170.9±33.4)ml.The average dominant blood loss was(410.1±23.6)ml.The mean invisible blood loss was(726.1±32.8)ml.The underground time was 1 ~ 3d,with an average of(1.8±0.3)d.The length of hospital stay was4 ~ 27 d,with an average of(10.9±1.3)d.No vascular or nerve injury occurred during the operation,and no complications such as dislocation of the prosthesis,periprosthesis fracture,deep venous thrombosis of lower extremities and deep hip joint infection occurred during the follow-up period.(2)This research object as the growth of the age,operation time is gradually diminishing,perhaps,thin and elderly patients,surgery tolerance ability is poorer,performer,as far as possible to shorten the operation time,intraoperative blood loss and subsequently showed a trend of decline,led traffic,hidden blood loss and postoperative hospital stay,the increasing trend and down time,may be related to elderly patients with poor bone,slowing down time;The vast majority of patients can abandon crutching and return to normal walking after 4~ 6 weeks,and can walk without barriers after 2 ~ 3 months.2.Visual simulation score of postoperative thigh painIn this study,postoperative thigh pain showed a significant trend of reduction,from the preoperative mean(7.95±0.46)points to the postoperative mean(3.49±0.32)points 3 months after surgery.Postoperative thigh pain may be related to the relatively long stalk body and the relatively large stalk body diameter on the femoral medullator wall and the heavy interference of the bone cortex.The average score of 6 months after the surgery was(2.44±0.41)points,12 months after the surgery was(1.86±0.32)points,and the average score of the last follow-up was(1.55±0.32)points.In the last follow-up,2 patients showed mild thigh pain,appeared when walking for too long,and disappeared when resting.3.Postoperative hip function assessmentThe Harris hip joint function score of 90 patients before and after surgery was significantly increased from the preoperative average of(44.5±4.5)to(91.2±3.4)at the lastfollow-up.SPSS 20.0 statistical software was used for statistical processing,and paired design t test was used.P<0.05 was considered statistically significant.4.X-ray examination was performed immediately after the operation(1)In this group of patients,limb length of lower limbs basically returned to normal after surgery,among which 72 patients(74 hips)had the same length of lower limbs after surgery,accounting for about 80%.Thirteen patients(15 hips)showed an increase of 1 ~ 2cm(mean1.5cm)in the affected limb,accounting for 14.5%.Five patients(5 hips)showed 0.5 ~ 1cm(mean 0.76cm)shrinkage after surgery,accounting for 5.5%.(2)In this group of patients,the initial fixation effect of femoral stem prosthesis in the medullary cavity was excellent.Kim three-point fixation method was used to measure the filling rate of prosthesis stalks in the medullary cavity.The average filling rate of prosthesis stalks on the positive X-ray films was 93.4±2.1%,and the average filling rate of lateral films was 82.3±2.5%.(3)X-ray immediately after the operation showed that the femoral stem prosthesis of the hip joint of 90 patients was fixed in neutral position in the medullary cavity.After the operation,6 patients presented mild varus deformity of the hip joint,the Angle of which was2.1 ~ 2.8°(mean 2.4±0.2°),but all ?3°,all within the normal range,without valgus deformity.(4)In this group,the postoperative femoral eccentricity was within the normal range.The femoral eccentricity of unilateral hip arthroplasty was 45 ~ 56mm(average 52±2.4mm),and the femoral eccentricity of bilateral hip arthroplasty was 46 ~ 55mm(average 51±3.5mm).5.Follow-up X-ray examination(1)In this group of patients,according to the Engh bone graft standard,bone graft was implanted to fix 67 hips,27 hips were fixed with stable fiber,and 0 hips were loosened by prosthesis 12 months after surgery.In the last follow-up,71 hips were fixed with bone growth,23 hips were fixed with stable fiber,and 0 hips were loosened with prosthesis.(2)This group of patients with postoperative follow-up of 12 months,56 hip with different degree of proximal femur stress shelter bone absorption,among them,the ? degrees(the femur is apart from the low density,and obtuse)41 hips,? degrees(involving small rotor)9hip,hip prosthesis handle and femur between bright area,but the width was < 1 mm;The last follow-up ? degrees(the femur is apart from the low density,and obtuse)63 hip,15 hip ?degrees(involving small rotor).(3)In this group of patients,12 months after the operation,the X-ray film showed that the subsidence interval of 21 hip femoral stem prosthesis was 1 ~ 6mm,with an average of2.8mm.The X-ray film in the last follow-up showed that the subsidence of 26 hip femoral stem prosthesis was 2 ~ 8mm,with an average of 4.5mm.(4)In this group,38 patients showed heterotopic ossification of the hip joint after 12 months of postoperative follow-up,among which 27 patients had grade I,9 patients had grade II,and 2 patients had grade III.In the last follow-up,there were 63 patients with heterotopic ossification of the hip joint,including 43 patients with grade I,12 patients with grade II,8 patients with grade III,and 2 patients with mild restricted motion during hip joint walking.(5)The Kim three-point fixation method was used to measure the filling rate of the prosthesis stalk in the medullary cavity.The positive position X-ray was >80%,and the lateral position X-ray was >70%,that is,the matching was satisfactory.The average filling rate of the prosthesis stalk in the positive position X-ray was 96.3±1.5%,and the average filling rate on the lateral position X-ray was 83.3±2.3%.In the 12 months after the operation,the average filling rate on the positive X-ray was 97.6±1.4%,the average filling rate on the lateral X-ray was 84.4±1.6%,the average filling rate on the positive X-ray was 98.2±1.2%,and the average filling rate on the lateral X-ray was 84.8±1.5%.(6)During the follow-up period,no complications such as perifemoral stem prosthesis fracture,hip arthrosis and loosening were found in all patients.Conclusions:1.The conical Wagner SL biological femoral stem prosthesis can well match the abnormally thick Dorr C "chimney-shaped" femoral bone marrow cavity.The postoperative femoral stem prosthesis has the advantages of high filling rate,good matching and fewer complications in the medullary cavity.2.Wagner SL type biological femoral prosthesis handle 2 ° taper design,article 8 of the chamfered edge crest,silicon carbide rough surface coating processing,handle all body and neck integration design ensures effectively the biomechanics of the fixed effects,and can effectively avoid the type of bone cement in artificial hip replacement,potential of the risk ofbone cement for elderly patients with cardiovascular and reduce the related clinical adverse factors.3.In patients with Dorr type C femoral bone marrow cavity undergoing hip replacement,the initial selection of Wagner SL biological femoral stem prosthesis has a good short-term clinical effect,which can help and guide joint surgeons to provide a reliable reference in the selection of treatment plan and prosthesis. |
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