非骨水泥股骨短柄假体治疗股骨颈骨折的进展

Advances in cementless short-stem femoral component for femoral neck fracture

髋关节置换术(total hip arthroplasty, THA)是骨科手术中最常见、最成功的手术之一,股骨颈骨折是髋关节置换术主要适应证。在临床应用中传统的非骨水泥股骨假体存在较高股骨骨折和塌陷的风险并增加了翻修的可能性,同时还存在近端-远端错配、非理想负荷转移、骨丢失、大腿疼痛和假体周围骨折等缺陷。在近二十年以来,髋关节置换术经历了一个不断发展的过程,短柄假体逐渐替代传统的非骨水泥股骨假体,并且具有一系列优点:保留骨量(高颈骨切除),保留股骨颈的解剖前倾,减少皮质应力,减少残余大腿疼痛,延长假体的使用寿命,更适用于微创手术等。目前,关于非骨水泥股骨短柄假体于股骨颈骨折的应用并无相关指南,更多依靠临床医生的经验。本文将从术中情况及术后并发症的多个角度阐述非骨水泥股骨短柄假体的优势及其应用现状。

Total hip arthroplasty(THA) is one of the most common and successful orthopedic surgeries with a main indication for femoral neck fracture. In clinical application, the traditional cementless femoral component is at higher risk of femoral fracture and collapse, which increases the possibility of revision. In addition, the traditional type of femoral component might have some deficiency, such as proximal-distal mismatch, non-ideal load transfer, bone loss, thigh pain, and periprosthetic fractures and so on. In the past two decades, hip arthroplasty has undergone a continuous development process, and short-stem prosthesis has gradually become a substitute for traditional cementless femoral component, and has a series of advantages, including keeping bone mass(high neck bone resection), keeping anatomic antegrade of femoral neck, reducing cortical stress, reducing residual thigh pain, prolonging the service life of prosthesis, and more suitable for minimally invasive surgery and so on. At present there are no relevant guidelines on the application of cementless short-stem femoral prosthesis in femoral neck fracture, and it mainly depends on the experience of clinicians. This paper aims to review the advantages of the cementless short stem femoral component regarding to intraoperative situation and postoperative complications.