Department of Orthopaedic Surgery, Pusan National University School of Medicine, Beomeo-ri, Mulgeum-eup, Yangsan 626-770, Korea.
Clin Orthop Relat Res. 2012 Apr;470(4):1158-64. doi: 10.1007/s11999-011-2139-9. Epub 2011 Oct 21.
Patients with neuromuscular disease reportedly have a higher incidence of postoperative dislocation after bipolar hemiarthroplasty. Although the literature has focused on a high prevalence of preoperative neurologic conditions in patients who had dislocations after bipolar hemiarthroplasties, the relative incidence of dislocation in patients with neuromuscular disease and without is unclear.
QUESTIONS/PURPOSES: We therefore (1) asked whether the incidence of postoperative dislocation after bipolar hemiarthroplasty was greater in patients with neuromuscular disease than for those without, and (2) whether function differed between the two groups, and (3) explored potential risk factors for dislocation in two groups.
We retrospectively reviewed 190 patients who underwent bipolar hemiarthroplasties for fracture of the femoral neck between 1996 and 2008. Of the 190 patients, 42 had various neuromuscular diseases and 148 had no history of neuromuscular disease. Intraoperative stability was tested and posterior soft tissue repair was performed in all patients. We determined the incidence of dislocation, postoperative leg length discrepancy, and femoral offset in patients with or without neuromuscular disease.
The incidence of dislocation was 2.6% in all patients. We observed similar rates of dislocation in the two groups: 4.8% (two of 42 hips) in patients with neuromuscular disease and 2.0% (three of 148 hips) in patients without neuromuscular disease.
In femoral neck fractures in patients with neuromuscular disease, careful preoperative management and operative technique such as a posterior soft tissue repair might decrease the risk of postoperative dislocation; therefore, we consider the bipolar hemiarthroplasty a reasonable treatment option.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
据报道，患有神经肌肉疾病的患者在接受双极半髋关节置换术后，术后脱位的发生率更高。尽管文献主要集中在双极半髋关节置换术后脱位患者术前神经状况高发，但患有神经肌肉疾病和无神经肌肉疾病患者脱位的相对发生率尚不清楚。
问题/目的：因此，我们（1）询问双极半髋关节置换术后脱位的发生率是否高于患有神经肌肉疾病的患者，以及（2）两组之间的功能是否存在差异，以及（3）探讨两组脱位的潜在危险因素。
我们回顾性分析了 1996 年至 2008 年间接受双极半髋关节置换术治疗股骨颈骨折的 190 例患者。190 例患者中，42 例患有各种神经肌肉疾病，148 例无神经肌肉疾病史。所有患者均进行了术中稳定性测试和后软组织修复。我们确定了有或没有神经肌肉疾病的患者的脱位发生率、术后肢体长度差异和股骨偏移。
所有患者的脱位发生率为 2.6%。我们观察到两组的脱位率相似：患有神经肌肉疾病的患者为 4.8%（42 髋中的 2 髋），无神经肌肉疾病的患者为 2.0%（148 髋中的 3 髋）。
在患有神经肌肉疾病的股骨颈骨折患者中，仔细的术前管理和手术技术（如后软组织修复）可能会降低术后脱位的风险；因此，我们认为双极半髋关节置换术是一种合理的治疗选择。
III 级，治疗研究。有关证据水平的完整描述，请参阅作者指南。
