生物型与骨水泥型假体全髋关节置换术治疗老年移位型股骨颈骨折的疗效分析  

Clinical efficacy comparison of total hip arthroplasty with biological prosthesis and bone cement prosthesis in elderly patients with displaced femoral neck fractures

作　　者：马超[1] 唐华羽[1] Ma Chao;Tang Huayu(Department of Orthopedics,The First Affiliated Hospital of Jiamusi University,Jiamusi,Heilongjiang 154000,China)

机构地区：[1]佳木斯大学附属第一医院骨科,黑龙江佳木斯154000

出　　处：《创伤外科杂志》2021年第4期301-304,共4页Journal of Traumatic Surgery

摘　　要：目的比较生物型与骨水泥型假体全髋关节置换术(THA)治疗老年移位型股骨颈骨折(DFNF)的临床疗效。方法前瞻性纳入2015年7月—2018年6月佳木斯大学附属第一医院骨科收治的老年DFNF患者128例,男性71例,女性57例;年龄61~84岁,平均72.7岁。骨折原因跌伤75例,撞伤32例,高处坠落伤21例。依据随机数字表法分为生物型假体THA组(BPTHA组,n=64)与骨水泥型假体THA组(CPTHA组,n=64)。BPTHA组行生物型假体髋关节置换,CPTHA组行骨水泥型假体髋关节置换。观察两组术中出血量、手术时间、术后引流量等围术期指标及住院时间。比较术前及术后6、12个月髋关节功能(Harris),血清前列腺素缓激肽(BK)、5-羟色胺(5-HT)等疼痛因子水平及视觉模拟评分(VAS),血清淀粉样蛋白A(SAA)、C反应蛋白(CRP)、红细胞沉降率(ESR)等炎性反应指标水平;分析术后并发症发生情况。结果两组术中出血量、手术时间、术后引流量差异均无统计学意义(P>0.05);BPTHA组住院时间长于CPTHA组(19.76±2.24)d vs.(15.37±1.71)d,P<0.05。术后6个月,BPTHA组Harris评分低于CPTHA组(81.72±8.37)分vs.(86.68±8.85)分,P<0.05;术后12个月,BPTHA组Harris评分高于CPTHA组(95.54±9.67)分vs.(90.72±9.12)分,P<0.05。术后6个月,BPTHA组血清BK、5-HT、SAA、CRP、ESR水平及VAS均高于CPTHA组(P<0.05);术后12个月,BPTHA组血清BK、5-HT、SAA、CRP、ESR水平及VAS均低于CPTHA组(P<0.05)。BPTHA组并发症发生率为3.13%,CPTHA组并发症发生率为4.69%,两组比较差异无统计学意义(P>0.05)。结论BPTHA、CPTHA均可应用于老年DFNF的临床治疗,但CPTHA近期疗效优于BPTHA,而BPTHA远期疗效优于CPTHA。Objective To compare the clinical efficacy of total hip arthroplasty(THA)with biological prosthesis and bone cement prosthesis in the treatment of displaced femoral neck fractures(DFNF)in the elderly.Methods Totally 128 elderly patients with DFNF were prospectively enrolled,who were admitted to the Department of Orthopedics of the First Affiliated Hospital of Jiamusi University from Jul.2015 to Jun.2018,and were randomly divided into the biological prosthesis THA group(BPTHA group,n=64)and the cemented prosthesis THA group(CPTHA group,n=64).Among them,there were 71 males and 57 females,with an average age of 72.7 years(range,61-84 years).There were 75 cases of falling injury,32 cases of bruises,and 21 cases of injuries from height falls.The BPTHA group underwent bioprosthetic hip replacement,and the CPTHA group underwent cemented hip replacement.Perioperative indicators such as intraoperative blood loss,operative time,postoperative drainage volume,and hospital stay were observed in the two groups.Hip joint function(Harris socre),serum prostaglandin bradykinin(BK),5-hydroxytryptamine(5-HT),visual analog scale(VAS),and inflammatory indicators such as serum amyloid A(SAA),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and postoperative complications were compared before operation at 6 and 12 months after operation.Results There was no significant difference in the amount of blood loss,operation time,and postoperative drainage between the two groups(P>0.05);the hospital stay in the BPTHA group was longer than that in the CPTHA group[(19.76±2.24)days vs.(15.37±1.71)days,P<0.05].At 6 months after operation,Harris score in the BPTHA group was lower than[(81.72±8.37)points]in the CPTHA group[(86.68±8.85)points],P<0.05;Harris score in the BPTHA group at 12 months after operation was higher than that in the CPTHA group[(95.54±9.67)points vs.(90.72±9.12)points,P<0.05].At 6 months after operation,the serum BK,5-HT,SAA,CRP,ESR,and VAS scores in the BPTHA group were higher than those in the CPTHA group(P<0.05

关 键 词：移位型股骨颈骨折 生物型 骨水泥型 假体 全髋关节置换术 老年 

分 类 号：R683.42[医药卫生—骨科学]