双极股骨头置换修复老年骨质疏松性髋部骨折:假体选择的争议

发布时间：2018-02-25 16:18

本文关键词： 假体植入髋骨折关节成形术骨质疏松骨科植入物人工假体股骨头置换老年人　出处：《中国组织工程研究》2015年39期 　论文类型：期刊论文

【摘要】：背景:老年髋部骨折患者数目巨大,该人群多合并多种内科疾病,全身一般情况较差,与全髋关节置换相比人工双极股骨头置换可以缩短手术时间,减少麻醉时间,提高安全性,但具体使用哪种固定方式一直存在争议。目的:比较老年骨质疏松性复杂髋部骨折患者应用生物型或骨水泥型股骨柄假体行人工双极股骨头置换的安全性及疗效差异。方法:选择2007年6月至2010年6月因骨质疏松性髋部骨折在新疆维吾尔自治区人民医院接受人工双极股骨头置换的75岁以上老年患者198例,按选用的假体类型分为两组,生物型组69例,骨水泥型组129例,两组置换后均常规治疗骨质疏松。比较两组患者手术时间、术中出血量、置换后髋部疼痛发生率、置换后下床活动时间、末次随访的Harris评分及假体松动率的差异。结果与结论:198例患者中176例获得为期48-84个月的随访,其中骨水泥组122例,生物型组54例。骨水泥组手术时间较生物型组长,但置换后下地负重时间早于生物型组,差异均有显著性意义(P0.05);置换后末次随访时松动及髋部疼痛的发生率骨水泥组多于生物型组,差异有显著性意义(P0.05);两组术中出血量、末次随访的Harris评分比较差异无显著性意义(P0.05)。在假体松动率方面,骨水泥组的发生率为5%,生物型组的发生率为4%,差异有显著性意义(P0.05)。提示应用生物型或骨水泥型髋关节假体行人工双极股骨头置换修复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、后期髋部疼痛及假体松动发生率均高于生物型假体。
[Abstract]:Background: there are a large number of elderly patients with hip fractures. This population is usually associated with many medical diseases, and the general situation is poor. Compared with total hip replacement, artificial bipolar femoral head replacement can shorten the operation time and reduce the anesthetic time. Improve safety, But the specific fixation method has been controversial. Objective: to compare the safety and efficacy of artificial bipolar femoral head replacement with biological or bone cement prosthesis in elderly patients with complicated hip fracture caused by osteoporosis. Methods: from June 2007 to June 2010, 198 patients over 75 years old who underwent artificial bipolar femoral head replacement in the people's Hospital of Xinjiang Uygur Autonomous region due to osteoporotic hip fracture were selected. According to the type of prosthesis selected, 69 cases in biological type group and 129 cases in bone cement type group were divided into two groups. Results and conclusion 176 patients with bone cement were followed up for 48 to 84 months, including 122 patients in bone cement group. The operation time of bone cement group was longer than that of biological type group, but the loading time after replacement was earlier than that of biological type group. The incidence of loosening and hip pain in bone cement group was higher than that in biological type group (P 0.05). There was no significant difference in Harris scores in the last follow-up. The incidence rate of bone cement group was 5 and that of biological type group was 4. The difference was significant (P 0.05). It was suggested that artificial bipolar femoral head replacement with biological or bone cement hip prosthesis was used to repair senile osteoporotic hip fracture. Have good medium and long term curative effect, Bone cement prosthesis can shorten the time of landing, but the time of operation, hip pain and loosening of prosthesis are higher than those of biological prosthesis.
【作者单位】：新疆维吾尔自治区人民医院骨科中心;
【分类号】：R687.3

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