骨水泥型与非骨水泥型双极股骨头假体置换治疗高龄股骨颈骨折合并骨质疏松症的临床效果评价

Clinical evaluation of cement and cementless bipolar femoral head prosthesis replacement in the treatment of femoral neck fracture with osteoporosis in the elderly

目的探讨骨水泥型与非骨水泥型双极股骨头假体置换治疗高龄股骨颈骨折合并骨质疏松症患者的临床效果,为临床假体选择提供依据。方法选取2016年1月至2017年12月大连大学附属中山医院收治的高龄股骨颈骨折合并骨质疏松症患者40例(40髋),根据选择假体类型的不同分为骨水泥组和非骨水泥组,每组20例。骨水泥组男9例,女11例,年龄80~95岁,平均(85.3±2.1)岁,均采用骨水泥型双极股骨头假体置换治疗;非骨水泥组男12例,女8例,年龄80~95岁,平均(83.3±4.1)岁,均采用非骨水泥型双极股骨头假体置换治疗。所有患者随访时间均≥12个月。比较两组患者的手术时间、术中出血量、术后引流量、负重时间以及并发症发生情况,并采用Harris评分系统进行髋关节临床功能评价。结果骨水泥组的手术时间为(55.23±5.65)min,明显长于非骨水泥组的(47.60±5.55)min,骨水泥组的术后完全负重时间为(35.62±13.17)d,明显短于非骨水泥组的(58.87±5.82)d,差异均有显著性(P<0.01),而两组患者的术中出血量、术后引流量、部分负重时间比较差异无显著性(P>0.05)。术后12个月两组髋关节功能Harris评分优良率分别为85%和80%,差异无显著性(P>0.05)。两组随访期间均未出现假体松动、下沉、脱位及切口感染等并发症。结论高龄并伴有骨质疏松的股骨颈骨折患者选择骨水泥型双极股骨头假体置换在早期负重方面优于非骨水泥型假体,近期临床疗效较好,但远期综合疗效尚需进一步验证。

Objective To explore the clinical eff ect of cemented non cemented bipolar femoral head prosthesis replacement in the treatment of elderly patients with osteoporotic femoral neck fracture,and to provide scientifi c basis for the selection of clinical prosthesis.Method From January 2016 to December 2017,40 elderly patients(40 hips)with femoral neck fracture and osteoporosis were selected from Zhongshan Hospital Affi liated to Dalian University.According to the type of prosthesis selected,they were divided into bone cement group and non bone cement group,with 20 cases in each group.There were 9 males and 11 females in the bone cement group,aged 80-95 years,with an average age of(85.3±2.1)years,who were all treated with cemented bipolar femoral head prosthesis replacement;12 males and 8 females in the non cemented group,aged 80-95 years,with an average age of(83.3±4.1)years,who were all treated with cemented bipolar femoral head prosthesis replacement.All patients were followed up for more than 12 months.The operation time,intraoperative hemorrhage,postoperative drainage,weight-bearing time and complications of the two groups were compared,and the clinical function of hip joint was evaluated by Harris scoring system.Result The operation time of bone cement group[(55.23±5.65)min]was longer than that of non bone cement group[(47.60±5.55)min],and the time of complete weight-bearing[(35.62±13.17)d]was shorter than that of non bone cement group[(58.87±5.82)d],the diff erences were signifi cantly(P<0.01),but there was no signifi cant diff erence between the two groups in the amount of intraoperative bleeding,the volume of postoperative drainage and the time of partial weight-bearing(P>0.05).The excellent and good rate of Harris score of hip joint function in the two groups was 85%and 80%respectively 12 months after operation,there was no signifi cant diff erence(P>0.05).There were no complications such as joint loosening,sinking,infection and dislocation during the follow-up of the two groups.Conclusion The cemented bipolar femoral head prosthesis replacement is better than the non cemented bipolar femoral head prosthesis replacement in the early load-bearing in the elderly patients with osteoporotic femoral neck fracture.The short-term clinical eff ect is better,but the long-term comprehensive eff ect needs to be further verifi ed.