Ong Bernard C, Maurer Stephen G, Aharonoff Gina B, Zuckerman Joseph D, Koval Kenneth J
Geriatric Hip Fracture Program, Department of Orthopedics, Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, U.S.A.
J Orthop Trauma. 2002 May;16(5):317-22. doi: 10.1097/00005131-200205000-00005.
This investigation was undertaken to compare a series of elderly individuals who sustained a displaced femoral neck fracture treated with either a cemented bipolar prosthesis or a cemented modular unipolar prosthesis.
A retrospective review of prospectively collected data.
Hospital-based tertiary care orthopaedic trauma practice.
Two hundred eighty-one community dwelling elderly patients sixty-five years of age or older who sustained a displaced femoral neck fracture (Garden Types III-IV) and underwent primary prosthetic replacement.
One hundred one patients received a cemented bipolar prosthesis and 180 received a cemented modular unipolar prosthesis.
The study was designed to determine whether there were any significant differences in: (a) the rate of prosthetic dislocation, postoperative medical and wound complications, or need for revision surgery, and (b) the functional outcome, including the incidence of hip pain and recovery of preinjury levels of ambulatory status and activities of daily living, at a minimum of thirty-six months of follow-up.
The two groups of patients did not differ in preinjury characteristics (age, sex, American Society of Anesthesiologist rating of operative risk, number of comorbidities, fracture type, activities of daily living, ambulatory status). There were no significant differences in the rates of postoperative medical or wound complications or dislocation. Ninety-two patients died during the period of study. Forty patients were lost to follow-up or refused to participate. Consequently, 149 patients were followed for a minimum of thirty-six months. Functional ability was compared between both groups with regard to recovery of ambulatory status and activities of daily living, as well as the incidence of hip pain at a minimum of thirty-six months of follow-up. No significant differences were found between the unipolar and bipolar groups.
Based on the results of this study, there does not appear to be any advantage to the use of a bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly. Furthermore, the extra cost of bipolar endoprostheses does not seem to warrant its use.
本研究旨在比较一系列接受骨水泥型双极假体或骨水泥型组合式单极假体治疗的老年股骨颈移位骨折患者。
对前瞻性收集的数据进行回顾性分析。
以医院为基础的三级骨科创伤治疗机构。
281名65岁及以上的社区老年患者，他们均发生股骨颈移位骨折（Garden III-IV型）并接受了初次假体置换。
101名患者接受骨水泥型双极假体，180名患者接受骨水泥型组合式单极假体。
本研究旨在确定以下方面是否存在显著差异：（a）假体脱位率、术后医疗及伤口并发症或翻修手术需求；（b）功能结局，包括髋部疼痛发生率以及伤前活动状态和日常生活活动能力恢复至伤前水平的情况，随访时间至少为36个月。
两组患者伤前特征（年龄、性别、美国麻醉医师协会手术风险分级、合并症数量、骨折类型、日常生活活动、活动状态）无差异。术后医疗或伤口并发症及脱位率无显著差异。92名患者在研究期间死亡。40名患者失访或拒绝参与。因此，149名患者接受了至少36个月的随访。比较了两组在随访至少36个月时的活动状态和日常生活活动能力恢复情况以及髋部疼痛发生率方面的功能能力。单极组和双极组之间未发现显著差异。
基于本研究结果，在老年股骨颈移位骨折的治疗中，使用双极假体似乎没有任何优势。此外，双极假体的额外成本似乎并不值得使用。
