半髋柄固定方式对高龄股骨颈骨折疗效的影响

目的探讨半髋置换股骨柄在股骨近端髓腔不同形态固定方式对高龄股骨颈骨折疗效的影响。 方法回顾分析2007年1月至2017年2月在东莞市人民医院关节外科分别连续收治的75岁以上高龄股骨颈骨折患者100例，纳入标准：Garden Ⅲ、Ⅳ型、骨折前尚能独立行走；排除标准：股骨颈病理性骨折、同侧髋骨关节炎、严重内科疾病不能耐受手术。分为骨水泥组和生物组。骨水泥组行骨水泥股骨柄双动头置换术，生物组行生物双动头置换术，对比骨水泥组与生物组术中并发症，术后假体周围骨折情况，股骨近端髓腔Noble分型，股骨假体的初始位置，假体松动情况及其末次随访时的髋关节功能Harris评分差异，计量资料对比采用t检验，计数资料比较采用卡方检验。 结果100例患者均获得随访平均(15 ± 3)个月。骨水泥组术中出现明显骨水泥反应2例，未出现死亡病例，术后有2例出现假体周围骨折(Vancouver分型VB2型和VC型)。生物组术中出现股骨距骨折6例(Vancouver分型VAL型)，术后假体周围骨折2例(Vancouver分型均为B2型)，术后3个月内出现髋关节后脱位1例。术后3个月内死亡2例，均为肾功能衰竭患者。股骨柄的位置安放在内或外翻位>3°为异常时，100例中仅生物组1例烟囱型髓腔出现内翻位置达4°，异常率仅为1%。骨水泥型股骨柄容易出现外翻位放置，生物型股骨柄容易出现内翻位放置。术后末次随访髋关节功能Harris评分骨水泥组和生物组优良率分别为89%和83%，两组差异无统计学意义(χ²＝0.44，P>0.05)。 结论生物无领矩形股骨柄(LCU股骨柄)与有领骨水泥股骨柄(Classic股骨柄)双动头置换治疗高龄股骨颈骨折患者在股骨近端不同类型的髓腔中均能获得良好的治疗效果。

Influence of fixation method of femoral component in hemiarthroplasty on outcomes of elderly patients with femoral neck fracture

ObjectiveTo explore effects of different fixation methods of femoral components in different types of proximal femoral medullary cavity using hemiarthroplasty on curative effect of the elderly patients with femoral neck fracture. MethodsFrom January 2007 to February 2017, 100 patients over 75 years old with femoral neck fracture consecutively treated respectively were chosen for the study. Garden Ⅲ、Ⅳ types were enrolled, while the patients with pathological fractures, and ipsilateral hip osteoarthritis were excluded. They were divided into two groups: the cemented group and the uncemented group. The cemented group underwent bipolar hemiarthroplasty with cement prosthesis and the uncemented group did with cementless one. The difference in the intraoperative complications, periprosthetic fractures, Noble classification of proximal femoral medullary cavity, initial position of femoral prosthesis, loosening of prosthesis and Harris score of hip function at last follow-up was compared between the two groups. The measurement data were compared by t test, and the enumeration data was done by chi-square test. ResultsAll 100 patients were followed up for(15±3)months on average. In the cemented group, there were two cases of obvious cement reaction during operation without death, and two cases of periprosthetic fracture after operation (Vancouver type VB2 and VC). In the uncemented group , there were six cases of femoral talus fracture (Vancouver type VAL), two cases of periprosthetic fracture (Vancouver type B2), and one case of posterior dislocation of hip within three months after operation. Two cases with renal failure died within three months after operation. The position of femoral stem placed in the varus or valgus position more than three degrees was considered as malposition, there was only one case with chimney-shaped medullary cavity in the uncemented group who had varus position of four degrees, and the abnormal rate was only 1%. It was easy to place cement femoral stem in the valgus position and cementless one in the varus positin. At the last follow-up, Harris score of hip function in the cemented group and the uncemented group was 89% and 83%, respectively. There was no statistically significant difference between the two groups (χ²=0.44, P>0.05). ConclusionThe treatment of elderly femoral neck fracture using cementless collarless rectangular femoral stem (LCU femoral stem) with bipolar hemiarthroplasty and collar cement femoral stem (Classic femoral stem) can achieve good therapeutic effect in different types of medullary cavity of proximal femur.