比较两种假体半髋置换治疗高龄不稳定转子间骨折

doi:10.3877/cma.j.issn.1674-134X.2022.01.020

目的

比较骨水泥型与生物型双极人工股骨头置换术治疗高龄不稳定性股骨转子间骨折的临床疗效。

方法

2013年1月至2017年1月，凉山州第一人民医院共收治94例高龄不稳定性股骨转子间骨折患者，分别采用骨水泥型股骨假体(骨水泥组，51例)或生物型股骨假体(生物组，43例)行双极人工股骨头置换术。所有患者均获得随访，随访终点时间为12个月或患者死亡。采用t检验或卡方检验比较两组患者临床疗效。

结果

两组患者术前一般资料比较，差异均无统计学意义(均为P>0.05)。骨水泥组患者术后伤口引流量(t＝3.964，P<0.05)及输血量(t＝5.245，P<0.05)均较生物组低，而手术时间较长(t＝3.535，P<0.05)。两组术中失血量、术后住院天数、术后下地活动时间、并发症、髋关节功能、及术后3个月和12个月死亡率比较，差异均无统计学意义(均为P>0.05)。所有患者均无假体松动需要翻修。

结论

采用半髋置换术治疗高龄不稳定性股骨转子间骨折，可获得满意的临床疗效；骨水泥型假体具有降低术后引流量及输血量的优点，同时增加手术时间的缺点。

关键词: 髋骨折, 老年人, 骨黏合剂, 关节成形术

Objective

To compare clinical outcomes of cemented and cementless bipolar hemiarthroplasty for the treatment of unstable intertrochanteric fractures in the elderly.

Methods

From January 2013 to January 2017, 94 elderly patients with unstable intertrochanteric fractures were treated by cemented bipolar hemiarthroplasty (the cemented group, n=51) or cementless bipolar hemiarthroplasty (the cementless group, n=43) in the First People′s Hospital of Liangshan. All the patients were followed up for 12 months or until the death of the patients. The clinical efficacy of the two groups was compared by t test or chi-square test.

Results

There was no significant difference in preoperative characteristics between the two groups (all P>0.05). The amount of postoperative drainage(t=3.964, P<0.05) and blood transfusion(t=5.245, P<0.05) in the cemented group were significantly lower, when compared with those in the cementless group. The operative time was significantly longer in the cemented group (t=3.535, P<0.05). There was no significant difference in intraoperative blood loss, postoperative hospital stay, postoperative bedtime, postoperative complications, hip function, or postoperative mortality in three and 12 months between the two groups (all P>0.05). None of the prosthesis was loosening or needed the revision.

Conclusions

The use of hemiarthroplasty in the treatment of unstable intertrochanteric fractures in elderly patients, can achieve satisfactory clinical outcomes. The cemented prosthesis can reduce postoperative drainage and the blood transfusion, while increasing the operation time.

Key words: Hip fractures, Aged, Bone cements, Arthroplasty

表1 两组患者术前一般资料比较

	骨水泥	生物组	统计值	P值
例数	51	43
年龄[岁，(±s)]	84.8±4.5	83.8±4.7	t ＝1.052	>0.05
性别[例，(男/女)]	7/44	12/31	χ²＝2.909	>0.05
体重[kg，(±s)]	59.8±7.4	61.2±8.2	t ＝0.870	>0.05
BMI(kg/m²)	22.5±5.8	23.3±6.2	t ＝0.646	>0.05
合并疾病患者数[例(%)]	31(60.8)	22(51.2)	χ²＝0.878	>0.05
Hb [g/L，(±s)]	108.6±12.8	106.4±13.6	t ＝0.807	>0.05
ASA分级[级，(±s)]	2.2±0.7	2.1±0.8	t ＝0.646	>0.05
AO/OTA分型(例)
31-A2.2	21	13	χ²＝1.210	>0.05
31-A2.3	30	30
Singh指数[级，(±s)]	2.8±0.7	3.1±0.9	t ＝1.817	>0.05
伤后至手术时间[d，(±s)]	2.5±1.2	2.7±1.1	t ＝0.836	>0.05

表1 两组患者术前一般资料比较

	骨水泥	生物组	统计值	P值
例数	51	43
年龄[岁，(±s)]	84.8±4.5	83.8±4.7	t ＝1.052	>0.05
性别[例，(男/女)]	7/44	12/31	χ²＝2.909	>0.05
体重[kg，(±s)]	59.8±7.4	61.2±8.2	t ＝0.870	>0.05
BMI(kg/m²)	22.5±5.8	23.3±6.2	t ＝0.646	>0.05
合并疾病患者数[例(%)]	31(60.8)	22(51.2)	χ²＝0.878	>0.05
Hb [g/L，(±s)]	108.6±12.8	106.4±13.6	t ＝0.807	>0.05
ASA分级[级，(±s)]	2.2±0.7	2.1±0.8	t ＝0.646	>0.05
AO/OTA分型(例)
31-A2.2	21	13	χ²＝1.210	>0.05
31-A2.3	30	30
Singh指数[级，(±s)]	2.8±0.7	3.1±0.9	t ＝1.817	>0.05
伤后至手术时间[d，(±s)]	2.5±1.2	2.7±1.1	t ＝0.836	>0.05

表2 两组患者术中、术后临床资料比较

	骨水泥组	生物组	统计值	P值
例数	51	43
手术时间[min，(±s)]	85.8±10.7	77.8±11.2	t ＝3.535	0.001
术中失血量[ml，(±s)]	309.6±65.4	295.8±55.5	t ＝1.091	>0.05
术后引流量[ml，(±s)]	266.8±94.6	369.7±154.2	t ＝3.964	<0.001
输血量[ml，(±s)]	229.6±93.2	335.7±102.8	t ＝5.245	<0.001
术后住院天数[d，(±s)]	4.8±1.5	5.2±1.6	t ＝1.249	>0.05
术后下地活动时间[d，(±s)]	1.8±0.9	2.0±0.7	t ＝1.186	>0.05
Harris评分[分，(±s)]	84.5±6.6	83.6±7.7	t ＝0.610	>0.05
术后并发症[例(%)]	7(13.7)	4(9.3)	-	0.541^*
术后3个月内死亡率[例(%)]	7(13.7)	3(9.3)	-	0.336^*
术后1年内死亡率[例(%)]	12(23.5)	7(16.3)	χ²＝0.760	>0.05

表2 两组患者术中、术后临床资料比较

	骨水泥组	生物组	统计值	P值
例数	51	43
手术时间[min，(±s)]	85.8±10.7	77.8±11.2	t ＝3.535	0.001
术中失血量[ml，(±s)]	309.6±65.4	295.8±55.5	t ＝1.091	>0.05
术后引流量[ml，(±s)]	266.8±94.6	369.7±154.2	t ＝3.964	<0.001
输血量[ml，(±s)]	229.6±93.2	335.7±102.8	t ＝5.245	<0.001
术后住院天数[d，(±s)]	4.8±1.5	5.2±1.6	t ＝1.249	>0.05
术后下地活动时间[d，(±s)]	1.8±0.9	2.0±0.7	t ＝1.186	>0.05
Harris评分[分，(±s)]	84.5±6.6	83.6±7.7	t ＝0.610	>0.05
术后并发症[例(%)]	7(13.7)	4(9.3)	-	0.541^*
术后3个月内死亡率[例(%)]	7(13.7)	3(9.3)	-	0.336^*
术后1年内死亡率[例(%)]	12(23.5)	7(16.3)	χ²＝0.760	>0.05

图1 左股骨转子间骨折行骨水泥型双极人工股骨头置换术治疗前后X线正位片。图A为术前，示左股骨转子间骨折(A2.3型)；图B为术后3 d左髋关节X线片，显示假体位置良好；图C为术后12个月左髋关节X线片，显示假体在位，无下沉松动

图2 左股骨转子间骨折行生物型双极人工股骨头置换术治疗前后X线正位片。图A为术前，示左股骨转子间骨折(A2.2型)；图B术后3 d左髋关节X线片，显示假体位置良好；图C为术后12个月左髋关节X线片，显示假体在位，无下沉松动

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Comparison of cemented and cementless bipolar hemiarthroplasties for aged unstable intertrochanteric fracture

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Comparison of cemented and cementless bipolar hemiarthroplasties for aged unstable intertrochanteric fracture