非骨水泥与骨水泥长柄翻修股骨假体周围骨折比较

Comparison of cementless versus cemented long stem in revision arthroplasty for periprosthetic femoral fractures

[目的]比较股骨假体周围骨折(periprosthetic femoral fracture, PFF)翻修术使用Zweymüller生物型长柄与传统骨水泥假体的临床效果。[方法]回顾性分析2017年6月~2019年6月本院翻修置换术治疗的PFF患者60例,其中,32例接受Zweymüller生物型长柄股骨假体翻修,28例接受骨水泥型长柄股骨假体翻修。比较两组围手术期、随访与影像资料。[结果]非水泥组手术时间、术中出血量、术后下地行走时间、住院时间均显著优于骨水泥组(P<0.05)。非水泥组完全负重活动时间显著早于骨水泥组(P<0.05)。与术后1个月相比,末次随访时,两组患者VAS评分显著下降(P<0.05),而Harris评分和髋伸屈ROM显著增加(P<0.05)。相应时间点,非水泥组VAS评分、Harris评分和髋伸屈ROM均显著优于骨水泥组(P<0.05)。影像方面,末次随访时,非水泥组股骨前倾角、颈干角和股骨前弓角均优于骨水泥组(P<0.05)。非水泥组骨折愈合时间显著早于骨水泥组(P<0.05)。[结论]对于股骨假体周围骨折的翻修置换术,采用非水泥假体的临床结果优于骨水泥型假体。

[Objective] To compare the clinical outcomes of revision arthroplasty for periprosthetic femoral prosthetic fractures(PFF)by using Zweymüller cementless long stem versus traditional cemented prosthesis. [Methods] A retrospective study was conducted on 60 patients who received revision arthroplasty for PFF in our hospital from June 2017 to June 2019. Of them, 32 patients received Zweymüller cementless long-stem femoral component for revision, while the remaining 28 had cemented long-stem prosthesis used. The perioperative follow-up and imaging data were compared between the two groups. [Results] The cementless group was significantly superior to the cemented group in operation time, intraoperative blood loss, time returning to walking after surgery and hospital stay(P<0.05). The cementless group returned to full weight-bearing activity significantly earlier than that of the cemented group(P<0.05). Compared with those at 1 month after surgery, the VAS score of the two groups of patients decreased significantly(P<0.05), while the Harris score and hip flexion-extension ROM increased significantly at the last follow-up(P<0.05). At the corresponding time point, the cementless group was significantly superior to the cemented group in VAS score, Harris score and hip flexion-extension ROM(P<0.05). In terms of imaging, the cementless group was significantly superior to the cemented group in femoral anteversion angle, neck shaft angle and femoral anterior arch angle at the last follow-up(P<0.05). The fracture healing time of the cementless group was significantly earlier than that of the cemented group(P<0.05). [Conclusion] For revision arthroplasty of periprosthetic femoral fractures, the cementless long-stem femoral component is considerably superior to the cemented counterpart in term of clinical outcomes.