The Measurement Of Proximal Femoral Medullary Cavity And The Comparative Study Of Different Types Of Cementless Femoral Prosthesis

PartⅠThe measurement of proximal femoral medullary cavity and the related research of selection of different types of femoral prosthesisObjective: (1) Through the study of the X-ray measurement of the anatomical parameters of 414 proximal femoral medullary cavity pre-operativly and the correlation among the parameters in 414 patients before total hip arthroplasty, made definite to the morphological characteristics of proximal femoral medullary cavity and the relationship between morphological characteristics with age and gender , the differences between Chinese and caucasian in morphological characteristics. (2) According to Nobel'classification of the morphological characteristics of proximal femoral medullary cavity and author's SUDA classification of metaphysis medullary cavity, to explore the significance describing the morphological characteristics of proximal femoral medullary cavity with CFI,MCFI,DCFI,internal diameter of isthmus and other parameters , providing evidence to the methods of fixation,selection of geometric types and design of artificial femoral prosthesis. Methods: Randomly selected the X-ray DICOM data of proximal femoral pre-operativly of 414 cases which had been performed THA from March 2005 to December 2008 in First Affiliated Hospital of Suzhou University , measured 10 parameters of diameter and five morphologyic parameters of proximal femoral medullary cavity with DICOM VIIEWER software, analysised the correlation among various parameters of proximal femoral and with gender,age, noted the name of femoral stem,classified the stem into 5 types: rectangular stem,anatomy stem,tapered round stem,cemented stem and cylinder stems according to methods of fixation and shape of stem. Analysed the proportion of all kinds femoral prosthesis respectively according to the classification of CFI and MCFI after THA. Results: 1,There was no significant correlation between the factor of age (male) with parameters of proximal femoral medullary cavity;but significant positive correlation between the factor of age (female) with the internal diameter of isthmus.2,According to Nobel'classification of proximal femoral medullary cavity, chimney-type (CFI <3.0) 54 cases possessed 13.0%, the normal type (3.0 4.7) 60 cases possessed 14.5%; author's classification of morphological characteristics of metaphysis medullary cavity (SUDA classification): MCFIⅠtype(MCFI <1.8) 41 cases possessed 9.9%; MCFIⅡtype(1.8 2.4) 91 cases possessed 22.0%;3,MCFI and CFI showed strong positive correlation, MCFI and internal diameter of isthmus had strongly negatively correlation, there was no significant correlation between MCFI and DCFI,opening angle of distal femoral medullary cavity; CFI showed strong positive correlation with DCFI,CI and the opening angle of distal femoral , CFI showed strong positive correlation with internal diameter of isthmus, DCFI had significant correlation with the opening angle of distal femoral medullary cavity.4,According to Nobel'classification: the proportions of all kinds femoral stems in the three types of proximal femoral medullary cavity as chimney-type,normal-type,funnel- type, rectangular stem possessed 19%,13%,13% respectively; anatomy stem possessed 7%,19%,18%; tapered round stem possessed 26%,45%,57%; cemented stem possessed 37%, 9%, 3%; cylinder stems possessed 11%,13%,8% respectively.5,according to the author's SUDA classification: the proportions of all kinds femoral stems in the three typesof metaphysis as MCFI I type,MCFIⅡtype,MCFIⅢtype, the rectangular stem possessed 20%,15%,10% respectively; anatomy stem possessed 20%,16%,20%; tapered round stem possessed 32%,44%,52%; cemented stem possessed 22%,13%,4%; cylinder stems possessed 7%,12%,14% respectively.Conclusion: 1,There was significant variation in the shape and size of proximal femoral medullary cavity, there was diference between Chinese and Caucasian to a certain degree.2,MCFI( metaphyseal canal flare index) and CFI(canal flare index) and DCFI(distal canal flare index) had different emphases on describing the morphological characteristics of proximal femoral medullary cavity, the three index combined with the parameters of diameter of proximal femoral medullary cavity could describ the shape of medullary cavity more precise and accurately.3,MCFI had an reference meaning for guiding the design and clinical application to the proximal fixed tapered round stem as well as CFI to the different geometric shape and fixed modus of femoral prothesis,DCFI to the design of distal shape of femoral prosthesis,parameters of medullary cavity of isthmus to the design of distal fixed cylinder stems as well.4,Suitable selection of chimney-type medullary cavity may be cemented stem or rectangular stem; normal-type medullary cavity could choose a variety of femoral prosthesis; funnel-type medullary cavity could choose tapered round femoral prosthesis.PartⅡThe comparative study of X-ray image and clinical observation on four different geometric-types of biological fixed artificial femoral prosthesis in early-term after total hip arthroplastyObjective: Through the comparative study of 117 cases (120 hips) of X-ray image and clinical result in early-term after THA with four different geometric-type biological fixed femoral prosthesis,explored the anatomical basis for design,clinical selection and application,clinical efficacy of four different geometric-types of cementless artificial femoral prosthesis,providing a reference data to the reasonable selection of different geometric-types prosthesis before THA.Method: from January 2003 to January 2008,randomly selected 117 cases (120 hips) which been performed THA in First Affiliated Hospital of Suzhou University according to four types of femoral stems,selected 29 cases of straight cylinder stem (30 hips):U2 stem(Taiwan hip joint); 30 cases of anatomical stem (30 hips): Ribbed stem (W. Link); 29 cases of tapered round stem (30 hips), which included 15 hips of F2L stem (Lima) and 15 hips of Synergy stem (Smith-Nephew,USA); 29 cases of rectangular stem (30 hips), which included 20 hips of C2 stem (Lima) and 10 hips of Betacone stem(W. Link), measured the X-ray-imaging signs of the four types femoral prosthesis in early-term after THA(1～6 years ,average 3 years); analysised and followed-up the clinical curative effect of the four types prosthesis with Harris hip score and standard indicators of clinical effects in early-term after THA.Results: to the 117 cases (120 hips) followed-up in early-term(average 3 years) after THA,the average Harris hip score of the patients preoperatively which adopted straight cylinder stem,anatomic stem,tapered round stem,rectangular stem was 35.9,36.1,38.3,28.9 points respectively; the average Harris hip score followed-up one year after THA was 93.5,93.8,95,92.3 points respectively, significantly higher than that of preoperatively (P <0.01); by excellent(90～100 points),good (80～89 minutes),general(70～79 minutes) and poor(69 points) rating, excellent and good rate of surgical results were 96.7%,93.3%,96.7%,96.7% respectively.Early curative effect of four different geometric patterns of biological fixed femoral stem after THA were satisfied overall,there were no significant difference by contrasting each other followed-up (P <0.01). the rates of thigh pain (mainly inⅠd egree) of four types of femoral stems postoperative were 26.67%, 16.67%, 16.67%, 20%, the thigh pain rates of straight cylinder stem was significantly higher than that of the others, showed significant differences. there was no significant difference in complications postoperatively such as dislocation,infection,DVT and so on , the revision rates of aseptic loosening of four geometric-types prosthesis were zero .Conclusion: The clinical efficacy of cementless THA proved reliably, four different geometric-types of cementless femoral prosthesis had characteristics of designs and application respectively, it is of great significance that select different geometric-types of cementless femoral prosthesis correctly according to the measurement of anatomical parameters of proximal femoral medullary cavity preoperatively to improving immediate stability postoperatively,preventing the sinking of femoral prosthesis,reducing stress shielding,getting initial and long-term biological fixation firmly;there was no significant difference of clinical efficacy and complications of four types biological fixed femoral prosthesis in early-term after THA.