两种股骨假体半髋置换治疗股骨颈骨折的比较

发布时间：2019-03-30 18:40

【摘要】：背景:研究认为单纯股骨头疾病而髋臼侧尚可的患者适合半髋置换,关于采用骨水泥型和非骨水泥型(即生物型)固定方式的适应证选择及近期和远期固定效果、并发症等差异的报道出入较大。目的:对比分析两种股骨假体半髋置换修复股骨颈骨折的效果及CT三维重建在移位性骨折中的应用。方法:回顾性分析73例股骨颈骨折全部行人工股骨头置换患者资料,分骨水泥假体组和非骨水泥假体组。并随访1.5年,比较各项手术指标、住院时间、髋关节功能,通过同时检查髋关节X射线片及三维CT,比较与术中所见的符合程度。结果与结论:(1)两组患者有效率差异无显著性意义(P0.05);(2)非骨水泥组手术时间少于骨水泥组(P0.05);置换中出血量骨、住院天数水泥组少于非骨水泥组且有统计学差异(P0.05);(3)置换后1个月骨水泥组关节Harris评分高于非骨水泥组(P0.05);置换后18个月非骨水泥组关节Harris评分高于骨水泥组(P0.05);置换后3,6,12个月两组评分无明显差异;(4)2组患者三维重建和术中所见无误差,符合率达100%;(5)结果提示,应综合考虑股骨颈骨折患者年龄、基础疾病、骨条件选择相应类型半髋置换,对于高龄且严重骨质疏松严重能接受手术的患者,建议选择骨水泥型假体;对骨量条件良好者优先考虑非骨水泥型;CT三维重建对移位型骨折诊断准确率及全面认识优于X射线片。
[Abstract]:Background: it is considered that the patients with simple femoral head disease but the acetabular side are suitable for hemi-hip replacement. The choice of indications and the short-term and long-term fixation effects of cement-type and non-cement-type (i.e. biological) fixation methods are considered to be suitable for the patients with simple femoral head disease. Reports of complications vary widely. Objective: to compare and analyze the effect of half hip replacement with two kinds of femoral prosthesis in the treatment of femoral neck fracture and the application of CT three-dimensional reconstruction in transposition fracture. Methods: the data of 73 patients with femoral neck fracture underwent artificial femoral head replacement were retrospectively analyzed, which were divided into two groups: bone cement prosthesis group and non-bone cement prosthesis group. Follow-up of 1.5 years was performed to compare the operative parameters, hospital stay, hip joint function. The X-ray and three-dimensional CT, of hip joint were examined simultaneously and compared with the degree of coincidence observed during the operation. Results & conclusion: (1) there was no significant difference in the effective rate between the two groups (P0.05); (2). The operation time in the non cement group was shorter than that in the cement group (P0.05). The time of hospitalization in cement group was less than that in non-cement group and there was statistical difference (P0.05); (3). The score of joint Harris in cement group was higher than that in non-cement group 1 month after replacement (P0.05). The Harris score of the non-bone cement group was higher than that of the cement group at 18 months after replacement (P0.05); there was no significant difference between the two groups at 3,6,12 months after replacement; (4) there was no error between the two groups in 3D reconstruction and intraoperative findings, and the coincidence rate was 100%. (5) the results suggest that the age, basic disease and bone condition of patients with femoral neck fracture should be considered, and the corresponding type of semi-hip replacement should be considered. For the elderly patients with severe osteoporosis and severe osteoporosis, it is suggested that the bone cement prosthesis should be chosen. Non-cement type was preferred for those with good bone mass, and CT 3D reconstruction was superior to X-ray film in the diagnosis accuracy and overall recognition of transposed fracture.
【作者单位】：中山大学附属第五医院脊柱外科;
【分类号】：R687.3

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