合并帕金森综合征的高龄股骨颈骨折初次髋关节置换术后假体生存分析

Analysis of prosthesis survival after primary hip arthroplasty in elderly patients with Parkinson's syndrome

目的:分析帕金森综合征对高龄股骨颈骨折初次髋关节置换术后假体生存期的影响。方法:回顾性分析2009年1月1日至2011年12月31日湘潭市中心医院骨科收治的高龄股骨颈骨折并行初次髋关节置换术患者81例(81髋),其中男36例,女45例。合并帕金森综合征患者16例(帕金森组),其他65例未合并帕金森综合征患者作为对照组。比较两组随访至2017年12月31日的假体生存状况(平均随访7.5年)。结果:随访期内帕金森组5例行髋关节翻修,翻修原因为4例假体周围骨折,1例无菌性松动,无脱位或感染者。对照组翻修7例,1例感染,4例无菌性松动,1例假体周围骨折,1例脱位。随访期内帕金森组翻修率为31.2%,对照组翻修率为10.8%,两组翻修率比较差异有统计学意义(P<0.05)。帕金森综合征是髋关节翻修的危险因素(OR=3.77,95%CI:1.12～3.15)。帕金森组假体周围骨折发生率明显高于对照组,差异有统计学意义(P<0.05)。两组之间无菌性松动、感染、脱位所致翻修的差异均无统计学意义(均P>0.05)。结论:在平均7.5年的随访期内,帕金森组行初次髋关节置换术后比对照组有更高的假体失败率,跌倒损伤所致假体周围骨折为最常见原因。制订个体化术式,施行循序渐进的康复锻炼,采取与之匹配的防护措施,加强帕金森综合征的药物管理及抗骨质疏松的治疗等,可能对提高此类患者假体生存期有积极意义。

Objective:To explore the effect of Parkinson’s syndrome on the survival of prosthesis after primary hip arthroplasty in elderly patients with femoral neck fracture.Methods:A total of 81 elderly patients(81 hips)with femoral neck fracture and primary hip replacement surgery,who came from the Department of Orthopaedics,Central Hospital ofXiangtan City from January 1,2009 to December 30,2010,were retrospectively analyzed,including 36 males and 45 females.Sixteen patients with Parkinson’s syndrome were selected as a Parkinson’s syndrome group,and the other 65 patients were served as a control group.The survival status of the prosthesis was followed up to December 30,2017 and it was compared between the 2 groups(average follow-up was 7.5 years).Results:During the follow-up period,5 patients in the Parkinson’s group underwent revision of the hip joint,and the reasons for revision were periprosthetic fracture in 4 patients and aseptic loosening in 1 patient,but there was no dislocation or infection.There were 7 cases of revision in the control group,including 1 case of infection,4 cases of aseptic loosening,1 case of periprosthetic fracture,and 1 case of dislocation.In the follow-up period,the revision rate was 31.2%in the Parkinson’s group and 10.8%in the control group(P<0.05).Parkinsonism was a risk factor for hip revision(OR=3.77,95%CI 1.12 to 3.15).The incidence of periprosthetic fractures in the Parkinson’s group was significantly higher than that in the control group(P<0.05).There was no statistical difference in the revision of the hip joint because of aseptic loosening,infection,and dislocation between the 2 groups(P>0.05).Conclusion:During an average of 7.5 years of follow-up,the older patients in the Parkinson’s syndrome group have higher prosthetic failure rates after primary hip arthroplasty than those in the control group.The periprosthetic fractures are the most common causes.The development of individualized surgical procedures,the implementation of step-by-step rehabilitative exercises,and the suitable protective measures,and the enhancement of drug management and anti-osteoporosis treatment for Parkinson’s syndrome may have positive implications for improving the survival of prosthesis in such patients.