双极人工股骨头置换术治疗老年股骨颈骨折的长期随访结果分析

Long-term outcomes of hemiarthroplasty for treatment of femoral neck fractures

目的 分析人工股骨头置换术治疗老年股骨颈骨折的长期疗效和导致二次翻修的危险因素。方法 回顾性分析自1990-02—2004-02采用人工股骨头置换术治疗303例（307髋）老年股骨颈骨折的临床资料。所有患者均采用骨水泥股骨柄,双极股骨头假体。评估假体翻修率,与手术相关的并发症（假体松动、髋臼内陷、死亡率）。结果 所有患者获得平均14.6（10-20）年随访。共29髋行翻修手术。末次随访时,23例（10.8%）因股骨柄假体无菌性松动、髋臼内陷及无菌性松动合并髋臼内陷需要翻修;单因素分析显示年龄较低（P=0.000）、男性（P=0.001）、生活习惯（P=0.005）与翻修率显著相关,多因素分析显示年龄（P=0.01）及性别（P=0.003）是影响术后翻修的独立危险因素。302例中17例发生早期并发症,213髋中,37髋发生无菌性并发症,晚期并发症多出现在年龄较小的老年患者,其中年龄≤75岁的患者再手术率为25.3%（19/75）,显著高于年龄〉75岁的2.9%（4/138）（P=0.000）。302例中,87例于1年内死亡,术后1年死亡率为28.8%、5年死亡率为63.9%。结论 采用骨水泥型人工股骨头置换治疗老年股骨颈骨折,年龄≤75岁及男性是导致术后翻修的危险因素;人工股骨头置换是治疗年龄〉75岁老年股骨颈骨折的有效、安全的方法。

Objective To investigate the long-term outcomes of the hemiarthroplasty for the treatment of femoral neck fractures and risk factors resulting in revision. Methods A retrospective analysis was made on the clinical data of 302 elderly patients（307 hips） with displaced femoral neck fractures who underwent hemiarthroplasty for the treatment of femoral neck fractures between February 1990 and February 2004. All patients were treated with a cemented bipolar curved femoral stem hemiarthroplasty prosthesis. These data were evaluated, including prosthesis revision rate, and surgery-related complications（loosening, acetabular protrusion, mortality）. Results All patients were followed-up with an average14.6（10-20）years. A total of 29 hips were revision surgery at the final follow-up. There were 23 patients（10.8%） were revision because of asepticloosening of the femoral prosthesis, protrusion of acetabular cup and asepticloosening cup; Univariate analysis showed that the age（P =0.000）, male（P =0.001）, living habit（P =0.005） were significantly associated with the rate of revision;multivariate analysis showedthat the age（P =0.01） and sex（P =0.003） were independent risk factors forpostoperative revision.All of 302 patients, there were 17 patients occurred early complications; all of 213 hips, there were 37 hips with aseptic complications.The late complications often were found in younger elderly patients. The rate ofreoperation in patients with aged ≤75 years was 25.3%（19/75）, which was significantlyhigher than the patients with aged 〉75 years which was 2.9%（4/138）（ P =0.000）. All of 302 patients, 87 patients were death within one year, the mortalityrate after one-year and five-year was 28.8%and 63.9%. Conclusion The cemented bipolar hemiarthroplasty is an effective and safe treatment for femoral neck fracture in patients older than 75 years; Apart from age below 75 years, male sex appeared to be predictive of a revision operation.