老年股骨颈骨折双侧同期非骨水泥型与骨水泥型人工全髋关节置换术临床疗效比较

Efficacy Comparison between Non-cemented and Cemented Prosthesis on Bilateral Total Hip Arthroplasty in Elderly Patients with Femoral Neck Fracture

【目的】比较老年股骨颈骨折双侧同期非骨水泥型与骨水泥型人工全髋关节置换术临床疗效。【方法】回顾性分析2014年3月至2015年6月本院骨科收治的147例股骨颈骨折手术患者的临床资料。根据患者全髋关节置换术选择假体类型的不同分为非骨水泥型假体组（NCP组）及骨水泥型假体组（CP组）。比较两组患者围术期指标、Harris评分及优良率、术后疼痛水平及围术期并发症发生率，综合评价两组·临床疗效。【结果】NCP组患者手术时间及术中出血量分别为（89．6±5．8）min、（83．5±14．6）mL均优于CP组的（119．7±8．2）min、（112-8±21.3）mL（P〈0．05）；两组患者住院时间（d）比较[（9．6±1．7）VS（9．8±1．6）d]差异无统计学意义（P〉0．05）。NCP组患者术后3个月、6个月Harris评分和优良率分别为（72．3±5．9）分、（65．8±5．1）分和72．2％、56．9％，均高于CP组的（61．5±4．4）分、（53．6±3．2）分和52．0％、37．3％（P〈0．05），但术后1个月其指标低于CP组。NCP组患者术后疼痛感（总疼痛率为33．3％）较NCP组（50．6％）轻（P〈0．05）；围术期并发症（褥疮、泌尿感染、切口感染及不良心血管事件）发生率亦较NCP组为低（7．0％vs20．0％，P〈0．05）。【结论】双侧同期非骨水泥型人工全髋关节置换术治疗老年股骨颈骨折效果更佳，可有效降低患者疼痛水平，减少围术期不良心血管事件等并发症的发生。其主要不足则在于即时固定（近期）效果不佳，临床医师应掌握不同类型假体的差异选择合适假体进行植入，以提高髋关节固定效果。

[Objective]To compare the clinical efficacy of simultaneous non-cemented and cemented pros- theses on bilateral total hip arthroplasty in elderly patients with femoral neck fractures.[Methods]The clinical data of 147 patients with femoral neck fracture admitted to our hospital from March 2014 to June 2015 were analyzed retrospectively. According to the type of the material for the total hip arthroplasty, patients were divided into the non-cemented prosthesis group （NCP group） and cemented prosthesis group （CP group）. The peroperative indexes, Harris score and excellent rate, postoperative pain and peroperative complications were compared between the two groups. The clinical efficacy of the two groups were evaluated. [Results]The operation time and intraoperative blood loss of patients in the NCP group were （89.6±5.8） rain and （83.5± 14.6） mL, respectively, which were significantly higher than those in the CP group, which were （119.7±8.2） and （112.8±21.3） mL （ P〈0.05）, respectively. There was no significant difference in hospitalization time （d） between the two groups [（9.6±1.7） vs （9.8± 1.6） d]（ P 〈0.05）. The Harris score and excellent and good rate in the NCP group were at 3 and 6 months after operation were （72.3±5.9）, （65.8±5.1） points and 72.2%, 56.9%, respectively, which were significantly higher than those in the CP group （61.5±4.4）, （53.6±3.2） points and 52.0%, 37.3% （ P 〈0.05）, respectively, but the index was lower than that of CP group one month after operation. The incidence of postoperative pain （total pain rate was 33.3 %） in the NCP group was lighter than that in the CP group （50.6 %） （ P 〈0.05）. The incidence of peroperative complications （bed sores, urinary tract infection, ineisional infection and adverse cardiovascular events） were also lower in the NCP group than the CP group （7.0% vs 20.0%, P 〈0.05）. [Conclusion]Bilateral simultaneous non-cemented total hip arthroplasty in the treatment of femoral neck fracture in elderly patients has better clinical effect,which can effectively reduce the patient pain level and reduce complications during perioperative adverse cardio- vascular events. The main shortcoming lies in that immediate fixation （short-term） ineffective. Therefore, clinicians should choose the appropriate implant for implantation according to the different types of prosthesis in order to improve the effect of hip joint fixation.