老年骨质疏松性髋部骨折全髋关节置换的假体类型选择  

Treatment of osteoporotic hip fractures by total hip replacement and prosthesis selection in the aged patients

作　　者：李祖涛 王利[1] 哈巴西.卡肯 徐阔[1] 陆林松[1] 袁宏[1] 

机构地区：[1]新疆维吾尔自治区人民医院骨一科,新疆乌鲁木齐830001

出　　处：《中国骨与关节损伤杂志》2015年第12期1240-1242,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的 比较老年骨质疏松性髋部骨折应用生物型或骨水泥型假体行全髋关节置换的安全性及疗效差异。方法笔者自2007-06—2010-06采用THA治疗骨质疏松性髋部骨折213例（〉60岁）,分别应用骨水泥型假体（骨水泥型组）和生物型假体（生物型组）,比较2组手术时间、术中出血量、术后髋部疼痛发生率、术后下地活动时间、术后4年的Harris评分、假体松动率及再手术率的差异。结果 213例中176例（骨水泥组47例,生物型组129例）获得平均64（48-84）个月随访。骨水泥组手术时间较生物型组长,术后下地负重时间早于生物型组,差异有统计学意义（P〈0.05）;骨水泥组术后末次随访松动率及髋部疼痛的发生率高于生物型组,差异有统计学意义（P〈0.05）;2组术中出血量、末次随访的髋关节功能Harris评分、再手术率比较差异无统计学意义（P〉0.05）。另外,骨水泥组与生物型组分别观察到2例和1例假体松动,因患者症状较轻,未进行二次手术。2组松动率比较差异有统计学意义（P〈0.05）。结论 生物型与骨水泥型髋关节假体治疗老年骨质疏松性髋部骨折均有较好的中长期疗效,骨水泥型假体可以缩短患者下地时间,但手术时间稍长、后期髋部疼痛及假体松动发生率均高于生物型。Objective To compare the therapeutic effects of total hip arthroplasty（THA） with cement or without cement in the treatment of femoral neck or intertrochanteric fractures in the aged patients. Methods A total of 213 osteoporotic patients with THA were enrolled and assigned into 2 groups from June 2007 to June 2010. Patients were assigned into cementless prosthesis group and cement prosthesis group. The operation time, intraoperative blood loss, rate of hip pain, bed-ridden time,Harris scores four years after operation were compared. The rate of fixation loosening and reoperation rate were also compared.Results A total of 176 cases（129 in cementless prosthesis group and 47 in cement prosthesis group） of above 213 cases were followed for an average time of 64 months（48 to 84 months）. The operation time of cement prosthesis group was significantly longer than that of cementless prosthesis group; The bed-ridden time of cement prosthesis was significantly shorter than that of cementless prosthesis group（P〈0.05）; The rate of hip pain and rate of fixation loosening in cementless prosthesis group were significantly higher than that of cement prosthesis group（P〈0.05）. There was no significant differences in intraoperative blood loss, Harris scores of last follow-up and rate of fixation loosening between two groups（P〉0.05）. Loosening was observed in 2cases and 1 case respectively in cement and cementless prosthesis group, but reoperation was not performed because symptoms of the patients were mild. Conclusion THA with and without cement both are feasible for the aged patients with hip fracture and osteoporosis with good middle and long term efficacy. THA with cement can reduce the bed-ridden time, but the rate of hip pain and the rate of prosthesis loosening are higher than that of THA without cement.

关 键 词：髋部骨折 全髋关节置换 骨质疏松 

分 类 号：R683.3[医药卫生—骨科学]