老年髋部骨折患者40mm双活动髋关节置换术与36mm头髋关节置换术后稳定性、步态和功能评分的比较

IF 1.9 2区 医学 Q2 ORTHOPEDICS
Clinics in Orthopedic Surgery Pub Date : 2025-02-01 Epub Date: 2024-12-09 DOI:10.4055/cios24148
Yonghan Cha, Sang-Yeob Lee, Ji-Ho Bae, Yang Jae Kang, Ji-Hoon Baek, Joon Soon Kang, Chan Ho Park, Shinjune Kim, Jun-Il Yoo
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引用次数: 0

摘要

背景:本研究旨在比较40mm直径双活动(DM)-全髋关节置换术(THA)与36mm陶瓷头(大头)THA治疗老年活动期髋部骨折患者的术中稳定性和早期临床结果。方法:于2022年5月至2022年12月进行前瞻性随机对照试验。纳入标准如下:年龄≥60岁,移位性股骨颈骨折,Koval 1级或2级,计划54毫米髋臼假体,随访1年以上。对所有患者进行术中稳定性测试(髋部骨折45°、60°和90°内旋)。术后6周和3个月分别评估功能结果(Harris髋关节评分和加州大学洛杉矶分校评分)。术后3个月采用人工智能(AI)技术进行步态分析。结果:纳入DM-THA患者36例,平均年龄69.6±2.2岁;44%女性)和37例大头THA患者(平均年龄69.6±1.2岁;64%的女性)。两组患者的功能结局和髋关节活动范围无统计学差异。然而,大头THA组与DM-THA组在步态速度和站立-摇摆相方面存在显著差异:DM-THA组的步态速度优于DM-THA组(2.85±0.83 kph vs 2.04±1.04 kph, p = 0.003),站立相比高于DM-THA组(手术侧:63.57%±3.82% vs 48.19%±5.50%,p < 0.001);对侧:62.77%±2.27% vs. 49.93%±6.94%,p < 0.001)。在髋关节屈曲90°的稳定性测试中,DM-THA组测量值为48.40°±5.17°,而大头THA组测量值为30.94°±2.98°(p = 0.012)。术中稳定性测试显示,两组在髋关节屈曲位置为60°时脱位角度差异有统计学意义(DM-THA组为51.60°±6.09°,大头THA组为40.00°±2.80°,p = 0.072)。结论:DM-THA术中稳定性测试和早期步态恢复优于大头THA。我们相信DM-THA可以成为老年髋部骨折患者THA的有效手术选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparing Stability, Gait, and Functional Score after 40-mm Dual-Mobility Hip Arthroplasty to 36-mm Head Hip Arthroplasty in Elderly Hip Fracture Patients.

Backgroud: This study aimed to compare the intraoperative stability and early clinical outcomes of 40-mm diameter dual mobility (DM)-total hip arthroplasty (THA) with 36-mm ceramic head (large head) THA in active elderly patients with hip fractures.

Methods: A prospective randomized controlled trial was conducted from May 2022 to December 2022. Inclusion criteria were as follows: age ≥ 60 years, displaced femoral neck fracture, Koval grade 1 or 2, planned 54-mm acetabular component, and over 1-year follow-up. Intraoperative stability tests were performed on all patients (internal rotation at 45°, 60°, and 90° of hip fracture). Functional outcomes (Harris Hip Score and University of California, Los Angeles [UCLA] Score) were evaluated at 6 weeks and 3 months postoperatively. Gait analysis using artificial intelligence (AI) techniques was conducted at 3 months postoperatively.

Results: The study included 36 DM-THA patients (mean age, 69.6 ± 2.2 years; 44% women) and 37 large head THA patients (mean age, 69.6 ± 1.2 years; 64% women). No statistically significant differences were observed in functional outcomes and hip range of motion between the 2 groups. However, there was a significant difference in the gait speed and stance-swing phase of the large head THA group and the DM-THA group: the DM-THA group demonstrated superior gait speed (2.85 ± 0.83 kph vs. 2.04 ± 1.04 kph, p = 0.003) and higher stance phase ratios (operated side: 63.57% ± 3.82% vs. 48.19% ± 5.50%, p < 0.001; opposite side: 62.77% ± 2.27% vs. 49.93% ± 6.94%, p < 0.001). In the stability test at 90° of hip flexion, the DM-THA group had a measurement of 48.40° ± 5.17°, while the large head THA group had a measurement of 30.94° ± 2.98° (p = 0.012). Despite the lack of statistical significance, the intraoperative stability test showed the dislocation angle was notably different between the groups in the hip flexion position of 60° (51.60° ± 6.09° in the DM-THA group and 40.00° ± 2.80° in the large head THA group, p = 0.072).

Conclusions: Superior results were observed in the intraoperative stability test and early recovery of gait after DM-THA compared to large head THA. We believe that DM-THA can be a useful surgical option for THA in elderly patients with hip fractures.

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来源期刊
CiteScore
3.50
自引率
4.00%
发文量
85
审稿时长
36 weeks
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