骨水泥与非骨水泥双动头假体治疗老年股骨颈骨折的比较

Cemented versus uncemented bipolar hemiarthroplasty for femoral neck fractures in the elderly

背景：现有文献对于骨水泥型与非骨水泥型人工全髋关节的研究已较为深入,而对于骨水泥与非骨水泥型人工双动型假体的疗效观察很少报道,对于骨水泥型及非骨水泥型假体之间有何差异,国内的研究很少。目的：比较骨水泥型与非骨水泥型双动头假体治疗老年股骨颈骨折的疗效。设计、时间及地点：对比观察,病例来自2004-01/2005-12西安市红十字会医院骨科。对象：选择西安市红十字会医院骨科收治的股骨颈骨折（GardenⅢ型和Ⅳ型）患者131例,男39例,女92例,年龄65~98岁,平均79岁。左髋72例,右髋59例。方法：置换前对患有不同程度基础疾病的患者给予相应治疗。入院后三四天进行股骨头置换治疗,均为同一术者操做,全部患者随机分为两组,其中骨水泥组采用骨水泥假体治疗;非骨水泥组采用非骨水泥假体治疗。置换后随访3年。采用Harris评分标准评估患髋。主要观察指标：两组患者肢体功能的恢复情况及髋关节Harris评分、死亡率、假体翻修率和并发症的发生。结果：随访期间骨水泥组6例患者死亡,非骨水泥组8例死亡。骨水泥组置换后3个月,43例患者可独立行走,15例需助步器辅助行走,5例仅能活动（卧床活动）。非骨水泥组27例患者可独立行走,35例需助步器辅助行走。骨水泥组9例患者住院时出现合并症,非骨水泥组有15例出现置换后并发症。置换后3年,骨水泥组有14例翻修（均为假体松动）,翻修率23.73%。而非骨水泥组仅有5例翻修,其中1例股骨干劈裂,4例假体松动,翻修率8.62%。置换后1年,两组患者髋关节Harris评分差异无显著性意义。两组患者随访期间髋臼磨损基本无差异,髓腔占有率非骨水泥组明显高于骨水泥组。两组患者置换后均未见假体脱位、异位骨化及骨溶解。结论：在随访期内骨水泥型和非骨水泥型双动头假体置换后患者髋关节功能之间无显著差异。

BACKGROUND： Many studies have been conducted about cemented and uncemented total hip arthroplasty （THA）. However, there are few reports about the differences between cemented and uncemented bipolar hemiarthroplasty in China. OBJECTIVE： To compare treatment effects of cemented and uncemented bipolar prostheses on fracture of femoral neck in the elderly. DESIGN, TIME AND SETTING： Comparative observation. The patients were selected from Department of Orthopaedics, Xi＇an Red Cross Hospital from January 2004 to December 2005. PARTICIPANTS： 131 cases of femoral neck fractures （type Garden Ⅲand Ⅳ） were selected from Department of Orthopaedics Xi＇an Red Cross Hospital, including 39 males and 92 females, aged 79 years （ranging 65-98 years）; 72 cases of left hip and 59 cases of right hip. METHODS： The patients with various basic diseases were given corresponding treatment before surgery. The operation was performed 3 or 4 days after admission by the same operator. The patients were randomly divided into two groups, who were separately treated with cemented or uncemented prostheses. The patients were followed up for 3 years after operation and the hip function was evaluated by Harris score. MAIN OUTCOME MEASURES： Hip function, Harris score, mortality revision rate, revision rate and complication incidence rate. RESULTS： During follow-up period, 6 in cemented group and 8 in uncemented group died. After 3 month of operation, 43 patients could walk independently, 15 needed walking aid, and 5 only acted on bed in cemented group. In uncemented group, 27 patients could walk independently, and 35 needed walking aid. In hospital, 9 patients of cemented group and 15 of uncemented group had complication. After 3 years of operation, 14 cases underwent revision in cemented group due to prosthesis loosening with revision rate of 23.73%, while only 5 patients underwent revision in uncemented group, including 4 cases of prosthesis loosening and 1 of femur split with a revision rate of 23.73%. One year after operation, there was no statistically significance in Harris scores between two groups. During follow-up period, there was no difference in acetabular abrasion between two groups, but the uncemented group had a higher medullary cavity possession rate. No prosthesis dislocation, heterotopic ossification, or bone dissolving was found. CONCLUSION： There were no differences in hip function between cemented and uncemented bipolar hemiarthroplasty for femoral neck fractures in the elderly during follow up.