高龄慢性肾功能不全股骨近端骨折生物型人工股骨头置换的中短期随访

Middle-and short-term follow-up of biological artificial femoral head replacement in elderly patients with proximal femoral fracture of chronic renal disease

背景:股骨近端骨折为老年人常见骨折,生物型人工股骨头置换是主要外科治疗方法之一,但是对伴有慢性肾功能不全的患者,其手术的安全性及修复效果报道结果差异很大。目的:分析高龄慢性肾功能不全股骨近端骨折患者进行生物型人工股骨头置换的中短期疗效。方法:纳入生物型人工股骨头置换治疗高龄(75岁及以上)股骨近端骨折患者53例,根据肾功能情况分为2组,慢性肾功能不全组25例,非慢性肾功能不全组28例。对比2组患者手术时间、术中出血量、输血量、术后24 h引流量、部分及完全负重时间、住院时间、住院费用以及并发症发生情况,比较随访时2组患者的髋关节功能Harris评分、双能X射线骨密度值、假体松动、假体周围骨溶解情况及假体生存率。结果与结论:(1)非慢性肾功能不全组1例患者置换后1个月死于呼吸衰竭,1例置换后3个月进行了翻修手术;慢性肾功能不全组1例置换后3个月死于心肺功能衰竭。2组其余患者完成了1-8年的随访,修复效果均满意;(2)慢性肾功能不全组及非慢性肾功能不全组置换后6个月髋关节功能Harris评分优良率分别为83%及85%,差异无显著性意义(P>0.05);(3)2组患者的手术时间、出血量、术后24 h引流量、部分及完全负重时间、双能X射线骨密度值差异均无显著性意义,但慢性肾功能不全组输血量更大,与非慢性肾功能不全组相比,住院时间长,住院费用多;(4)2组患者术后随访时均有不同程度的假体周围骨溶解,但无明显假体松动;非慢性肾功能不全组1例患者因反复假体脱位最终翻修,慢性肾功能不全组及非慢性肾功能不全组假体生存率分别为100%及96%,差异无显著性意义(P>0.05);(5)结果提示,对于合并慢性肾功能不全的高龄股骨近端骨折患者,经过周密的术前准备,应用生物型人工股骨头置换可取得良好的修复效果,患者肢体功能改善明显。

BACKGROUND： Fracture of the proximal femur is common in the elderly. Biological artificial femoral head replacement is one of the main methods of surgical treatment, but in the patients with chronic renal disease, the surgical efficacy and safety are variously reported. OBJECTIVE： To analyze the middle- and short-term effects of biological artificial femoral head replacement in elderly patients with proximal femoral fracture of chronic renal disease. METHODS： Biological artificial femoral head replacement was used to treat 53 patients with proximal femoral fractures （aged 75 years and over）. They were divided into two groups according to renal function： chronic renal disease group （n=25） and non-chronic renal disease group （n=28）. Operation time, intraoperative blood loss, intraoperative blood transfusion, postoperative drainage volume of 24 hours, and partial and complete weight-bearing time, hospitalization time, hospitalization expenses and complications were compared between the two groups. Harris hip joint function score, dual energy X-ray bone density, prosthesis loosening, periprosthetic osteolysis and implant survival rate were compared in the two groups during follow-up. RESULTS AND CONCLUSION： （1） In the non-chronic renal disease group, one patient died of respiratory failure at 1 month after replacement, and one case was refurbished at 3 months after replacement. In the chronic renal disease group, one patient died of cardiopulmonary failure at 3 months after replacement. Other patients in both groups were followed up for 1-8 years. The repair efficacy was satisfactory. （2） The excellent and good rate of hip function Harris score was 83% and 85% at 6 months after operation in chronic renal disease group and non-chronic renal disease group, respectively （P 〉 0.05）. （3） No significant differences in operation time, blood loss, the volume of drainage 24 hours after the operation, the partial and complete weight-bearing time and dual energy X-ray bone density were determined between the two groups. The blood transfusion was larger; hospitalization time was longer; hospitalization expenses were more in the chronic renal disease group compared with the non-chronic renal disease group. （4） Patients in the two groups experienced different degrees of osteolysis, but no obvious prosthesis loosening was found. One patient in the non-chronic renal disease group underwent revision because of repeated dislocation of the prosthesis. The survival rates of the prosthesis in the chronic renal disease group and non-chronic renal disease group were 100% and 96% respectively （P 〉 0.05）. （5） For elderly patients with proximal femoral fracture of chronic renal disease, the biological artificial femoral head replacement obtained good repair efficacy, and the function of the limbs was improved obviously with careful preoperative preparation.