骨水泥和非骨水泥型人工股骨双动头置换的临床疗效分析

Treatment effects comparison of cemented and uncemented bipolar prostheses on displaced fracture of femoral neck in the elderly

[目的]比较骨水泥型与非骨水泥型人工股骨双动头治疗老年移位型股骨颈骨折的疗效。[方法]本科2005年1月～2007年5月收治的股骨颈骨折(GardenⅢ、Ⅳ型)患者100例,其中男31例,女69例,年龄70～98岁,平均78.3岁。左髋52例,右髋48例。手术均为同一术者操作,全部患者随机分为两组,各50例,采用骨水泥和非骨水泥股骨假体治疗。术后随访5年。主要观察指标:手术时间,术中失血,并发症,视觉模拟评分,髋关节Harris评分、病死率和假体翻修率。组间比较采用两样本t检验,P<0.05为差异有显著性意义。[结果]骨水泥组手术时间平均57min,非骨水泥组平均47min,术中失血骨水泥组平均238ml,非水泥组230ml。视觉模拟评分及Harris评分两组无明显差异。手术并发症:非水泥组(28例)多于水泥组(21例)。两组均未见明显髋臼磨损。翻修非水泥组(2例)多于水泥组(1例)。随访各时间点的死亡率两组无明显差异。[结论]人工股骨双动头治疗老年股骨颈移位骨折,在手术时间上,非水泥组占优,并发症方面,骨水泥组占优,术中失血,视觉模拟评分,髋关节Harris评分,髋臼磨损率,病死率和假体翻修率方面两组没有显著差别。

[ Objective] To compare treatment effects of cemented and uncemented bipolar prostheses on displaced fracture of femoral neck in the elderly. [ Method]The 100 patients of femoral neck displaced fractures （type Garden III and IV ） were selected from Orthopaedic Center the 88th Hospital of PLA from January 2005 to May 2007 ,including 31 males and 69 females, aged 78.3 years （ ranging 70 to 98 years） years,52 cases of left hip and 48 cases of right hip. The operation was performed by the same operator. All patients were randomly divided into two groups,50 cases of cemented and 50 cases of uncemented femoral prosthesis treatment. The patients were followed up for 5 years. The operative time, intraoperative blood loss, complications, visual analogue scale, Harris hip score, mortality and revision rate were compared respectively. The results was evaluated by the paired t test. P 〈 0.05 was considered as having significant difference. [ Result] The average operative time of cement group was 57 minutes,while the unccmented group was 47 minutes. The average intraoperative blood toss was 238 ml, while the uncemented group was 230 ml. The visual analog scale and the Harris hip score did not differ significantly between the groups. The total number of complications was greater in the uncemented group （28 cases compared with 21 cases in the cemented group）. Acetabular wear did not differ significantly between the groups. The number of revision was greater in the uncemented group （3 cases compared with 2 cases in the cemented group）. The mortality rate did not differ significantly between the groups at any time point. [ Conclusion] For bipolar hemiarthroplasty for femoral neck fractures in the elderly during follow up, the uncementcd group did better in the operative time,while the cemented group did better in complications. There were no differences between cemented and uncemented in intraoperative blood loss, visual analogue scale, Harris hip score, acetabular wear rate, mortality and revision rate.