生物型与骨水泥型假体半髋置换治疗老年不稳定性股骨转子间骨折的比较

发布时间：2018-08-31 15:37

【摘要】：背景:目前对不稳定性老年股骨转子间骨折是采用骨水泥型还是生物型半髋置换治疗还存在争论,因此有必要进一步研究此两种方法的有效性和安全性的差异。目的:比较生物型与骨水泥型半髋置换治疗老年不稳定性股骨转子间骨折临床疗效差异。方法:回顾性分析枣庄矿业集团中心医院骨科2009年5月至2014年5月间收治的93例老年不稳定性股骨转子间骨折患者的临床资料,根据假体类型不同将患者分为2组,骨水泥组54例采用骨水泥型股骨假体行双极人工股骨头置换,生物组39例采用生物型股骨假体行双极人工股骨头置换。结果与结论:(1)与生物组相比,骨水泥组患者术后引流量、输血量较低(P0.05),但手术时间较长(P0.05);(2)两组患者术中出血量、术后离床活动时间、术后住院天数、术后并发症、髋关节功能、术后3个月及1年死亡率差异均无显著性意义(P0.05);(3)两组患者术后即刻X射线片检查显示,假体位置良好,共10例(骨水泥组3例,生物组7例)患者术后发生假体下沉,但下沉距离均小于3 mm;(4)随访期间未见患者出现异位骨化、假体周围骨溶解及髋臼软骨磨损,共25例(骨水泥组16例、生物组9例)患者在随访期间死亡,假体均无松动,其他患者68例患者随访时间2-7年,平均(4.5±2.3)年,未出现假体松动需要翻修;(5)结果证实,对于老年不稳定性股骨转子间骨折,采用生物型或骨水泥型半髋置换,均可获得满意的疗效,安全可靠,其中骨水泥型假体具有降低术后引流量及输血量的优点。
[Abstract]:Background: it is still controversial whether to treat unstable intertrochanteric femoral fractures with bone cement or biological semi-hip replacement. Therefore, it is necessary to further study the difference between the effectiveness and safety of these two methods. Objective: to compare the clinical effects of biologic and bone cement hemihip replacement in the treatment of unstable intertrochanteric fractures in the elderly. Methods: the clinical data of 93 elderly patients with unstable intertrochanteric fracture of femur were analyzed retrospectively from May 2009 to May 2014 in Orthopaedics Department of Zaozhuang Mining Group Central Hospital. The patients were divided into two groups according to the type of prosthesis. Bone cement group (54 cases) were treated with bone cement type femoral prosthesis and biological group (39 cases) with bipolar femoral head replacement. Results and conclusion: (1) compared with the biological group, the postoperative drainage volume and blood transfusion volume in the bone cement group were lower than those in the biological group (P0.05), but the operation time was longer (P0.05); (2). There was no significant difference in mortality between 3 months and 1 year postoperatively (P0.05); (3). X ray examination showed that the prosthesis was in good position in 10 cases (3 cases in bone cement group and 7 cases in biological group). However, there was no heterotopic ossification, osteolysis and wear of acetabular cartilage in 25 patients (16 cases in the cement group and 9 cases in the biological group) during the follow-up period, and no loosening of the prosthesis was found in all of the 25 cases (16 cases in the bone cement group and 9 cases in the biological group). 68 patients with other patients were followed up for 2-7 years (mean 4.5 卤2.3 years), and no prosthetic loosening needed revision. (5) the results confirmed that in the case of unstable intertrochanteric fractures in the elderly, biologic or cemented semi-hip replacement was used. All of them have satisfactory curative effect, safety and reliability, among which bone cement prosthesis has the advantages of reducing postoperative drainage and blood transfusion.
【作者单位】：徐州医科大学;山东省枣庄矿业集团中心医院骨科;
【分类号】：R687.4

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