全羟基磷灰石涂层 Corail 柄因股骨颈骨折而固定：38 例患者 RSA 和 DEXA 随访 2 年。

BACKGROUND

Today, dislocated femoral neck fractures are commonly treated with a cemented hip arthroplasty. However, cementing of the femoral component may lead to adverse effects and even death. Uncemented stems may lower these risks and hydroxyapatite (HA) coating may enhance integration, but prosthetic stability and clinical outcome in patients with osteoporotic bone have not been fully explored. We therefore studied fixation and clinical outcome in patients who had had a femoral neck fracture and who had received a fully HA-coated stem prosthesis.

PATIENTS AND METHODS

50 patients with a dislocated femoral neck fracture were operated with the fully HA-coated Corail total or hemiarthroplasty. 38 patients, mean age 81 (70-96) years, were followed for 24 months with conventional radiographs, RSA, DEXA, and for clinical outcome.

RESULTS

31 of the 38 implants moved statistically significantly up to 3 months, mainly distally, mean 2.7 mm (max. 20 mm (SD 4.3)), and rotated into retroversion mean 3.3º (-1.8 to 17) (SD 4.3) and then appeared to stabilize. Distal stem migration was more pronounced if the stem was deemed to be too small. There was no correlation between BMD and stem migration. The migration did not result in any clinically adverse effects.

INTERPRETATION

The fully hydroxyapatite-coated Corail stem migrates during the first 3 months, but clinical outcome appears to be good, without any adverse events.

背景

如今，股骨颈骨折通常采用骨水泥髋关节置换术进行治疗。然而，股骨部件的骨水泥固定可能会导致不良后果，甚至死亡。非骨水泥柄可能会降低这些风险，而羟基磷灰石（HA）涂层可能会增强整合，但在骨质疏松症患者中，假体的稳定性和临床结果尚未得到充分探索。因此，我们研究了接受全 HA 涂层股骨柄假体治疗的股骨颈骨折患者的固定和临床结果。

患者和方法

50 例股骨颈骨折脱位患者采用全 HA 涂层 Corail 全髋关节或半髋关节置换术进行手术。38 例患者，平均年龄 81 岁（70-96 岁），接受了 24 个月的常规 X 线、RSA、DEXA 和临床结果随访。

结果

38 个植入物中有 31 个在 3 个月内发生了统计学上的显著移动，主要是向远端，平均 2.7 毫米（最大 20 毫米（SD 4.3）），并旋转进入后倾，平均 3.3 度（-1.8 至 17）（SD 4.3），然后似乎稳定下来。如果认为柄太小，远端柄迁移更为明显。骨密度与柄迁移之间没有相关性。这种迁移没有导致任何临床不良后果。