长柄与普通柄半髋置换治疗老年股骨粗隆间骨折△

Cemented long- stem versus standard- stem femoral components in hemiarthroplasty for unstable intertrochanteric frac⁃ tures in the elderly

摘要:

［目的］比较骨水泥型长柄和普通柄半髋置换治疗老年不稳定型股骨粗隆间骨折的临床疗效。［方法］回顾性分析本院 2016 年 1 月—2020 年 1 月采用骨水泥型假体半髋置换治疗的 120 例老年股骨粗隆间骨折患者的临床资料。根据医患沟通结果，60 例采用骨水泥型长柄，60 例采用普通柄。比较两组围术期、随访及影像结果。［结果］两组患者均顺利完成手术，术中均无严重并发症。两组手术时间、术中失血量、术中透视次数、术后引流量、切口愈合等级、住院时间方面的差异均无统计学意义（P>0.05），但长柄组的手术切口长度显著长于普通柄组（P<0.05），下地行走时间显著早于普通柄组（P<0.05）。两组获得完整随访 12 个月以上的患者共 107 例，两组恢复完全负重活动时间的差异无统计学意义（P>0.05）。术后随时间推移，两组 Harris 评分、髋关节伸-屈 ROM、髋内旋-外旋 ROM 均显著增加（P<0.05），相应时间点，两组间上述指标的差异均无统计学意义 （P>0.05）。影像方面，两组骨折复位质量、骨折愈合时间、双侧股骨长度差的差异均无统计学意义 （P>0.05）。［结论］ 骨水泥型长柄和普通柄假体的半髋置换均可用于老年不稳定型股骨粗隆间骨折患者的治疗，术后的短期疗效似乎没有明显差别， 但长期疗效还有待进一步随访研究。

Abstract:

[Objective] To compare the clinical outcomes of cemented long-stem (LS) versus standard-stem (SS) femoral components in hemiarthroplasty (HA) for unstable intertrochanteric fractures in the elderly. [Methods] A retrospective study was performed on 120 el- derly patients who received HA for unstable femoral intertrochanteric fractures in our hospital from January 2016 to January 2020. Accord- ing to the results of doctor-patient communication preoperatively, 60 patients had cemented LS used, while the remaining 60 patients re- ceived SS. The perioperative period, follow- up and imaging data were compared between the two groups. [Results] All patients in both groups had HA performed successfully without serious complications. There were no significant differences in operation time, intraoperative blood loss, intraoperative fluoroscopy times, postoperative drainage volume, incision healing grade, and hospital stay between the two groups (P＞0.05) , but the LS group had significantly longer incision length than the SS group (P＜0.05) , and the former resumed postopera- tive walking significantly earlier than the latter (P＜0.05) . Of them, a total of 107 patients were followed up for more than 12 months, and there was no a significant difference in the time to return full weight-bearing activities between the two groups (P＞0.05) . The Harris score, hip extension-flexion range of motion (ROM) and hip interna-external rotation ROM increased significantly in both groups over time (P＜ 0.05) , whereas which proved not significantly different between the two groups at any corresponding time points (P＞0.05) . Radiographical- ly, there were no significant differences in the quality of fracture reduction, fracture healing time, and bilateral femoral length discrepancy between the two groups (P＞0.05) . [Conclusion] Both long-stem and standard-stem femoral components used in hemiarthroplasty are effec- tive treatment for unstable intertrochanteric fractures in the elderly without significant difference in term of short-term outcomes, however, the consequences in long term needs to be further studied.