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全髋关节置换术后脱位的风险可通过保留型髋臼杯降低。

The risk of dislocation after total hip arthroplasty for fractures is decreased with retentive cups.

机构信息

Department of Orthopaedic Surgery, University Paris East, Hôpital Henri Mondor, 94010, Creteil, France.

出版信息

Int Orthop. 2013 Jul;37(7):1219-23. doi: 10.1007/s00264-013-1911-8. Epub 2013 May 12.

Abstract

PURPOSE

Total hip arthroplasty (THA) has been efficacious for treating hip fractures in healthy older patients. However, in those patients with fractures a widely variable prevalence of dislocation has been reported, partly because of varying durations of follow up for this specific end-point. The purpose of the present study was to determine the cumulative risk of dislocation in these patients with fractures and to investigate if retentive cups decrease the risk of dislocation.

METHODS

Between 2000 and 2005, 325 patients with neck fracture underwent primary THA using a retentive (325 hips) cup. The results of these 325 acetabular cups were compared to 180 THA without retentive cups performed for neck fractures in the same hospital between 1995 and 2000 by the same surgical team. The mean age of the 505 patients was 75 years (range 65-85). All patients were followed for a minimum of five years for radiographic evidence of implant failure. The patients were followed at routine intervals and were specifically queried about dislocation. The cumulative risk of dislocation and recurrent dislocation was calculated with use of the Kaplan-Meier method.

RESULTS

For patients without retentive cups, the cumulative risk of a first-time dislocation was 5 % at one month and 12 % at one year and then rose at a constant rate of approximately 1 % every year to 16 % at five years. For patients with retentive cups, the cumulative risk of a first-time dislocation was 1 % at one month, 2 % at one year and then did not changed at five years. There were no differences in the mortality rates or in loosening rates among the treatment groups. The rate of secondary surgery was highest in the group without retentive (10 % for recurrent dislocation) compared with 1 % in the group treated with retentive cups. In absence of retentive cups, multivariate analysis revealed that the relative risk of dislocation for female patients (as compared with male patients) was 2.1 and that the relative risk for patients who were 80 years old or more (as compared with those who were less than 80 years old) was 1.5. Two underlying diagnoses occurring during follow up-cognitively impaired patients or neurologic disease-were also associated with a significantly greater risk of dislocation in absence of retentive cup. For these patients the risk was also decreased with a retentive cup.

CONCLUSION

With standard cups the incidence of dislocation is highest in the first year after arthroplasty and then continues at a relatively constant rate for the life of the arthroplasty. Patients at highest risk are old female patients and those with a diagnosis of neurologic disease. Retentive cups in these patients are an effective technique to prevent post-operative hip dislocation.

摘要

目的

全髋关节置换术(THA)已被证明对治疗健康老年患者的髋部骨折有效。然而,在这些骨折患者中,脱位的发生率差异很大,部分原因是因为该特定终点的随访时间不同。本研究的目的是确定这些骨折患者脱位的累积风险,并探讨保留杯是否降低脱位风险。

方法

2000 年至 2005 年间,325 例颈骨折患者采用保留(325 髋)杯行初次 THA。通过同一手术团队在同一医院于 1995 年至 2000 年间进行的 180 例无保留杯的颈骨折 THA,比较了这 325 个髋臼杯的结果。505 例患者的平均年龄为 75 岁(65-85 岁)。所有患者均至少随访 5 年,以评估影像学假体失败的证据。患者定期随访,并特别询问脱位情况。使用 Kaplan-Meier 法计算脱位和复发性脱位的累积风险。

结果

对于无保留杯的患者,首次脱位的累积风险在 1 个月时为 5%,在 1 年时为 12%,然后以每年约 1%的恒定速率上升,在 5 年时达到 16%。对于保留杯的患者,首次脱位的累积风险为 1 个月时为 1%,1 年时为 2%,然后在 5 年内没有变化。治疗组之间的死亡率或松动率没有差异。无保留杯组的二次手术率最高(复发性脱位 10%),而保留杯组为 1%。在无保留杯的情况下,多变量分析显示,女性患者(与男性患者相比)的脱位相对风险为 2.1,80 岁或以上患者(与 80 岁以下患者相比)的相对风险为 1.5。在随访期间出现的两种潜在诊断——认知障碍患者或神经疾病——也与无保留杯时脱位的风险显著增加相关。对于这些患者,保留杯也降低了脱位的风险。

结论

使用标准杯,关节置换术后第一年脱位发生率最高,然后在关节置换的整个生命周期内以相对稳定的速度继续。风险最高的是老年女性患者和患有神经疾病的患者。对于这些患者,保留杯是预防术后髋关节脱位的有效技术。

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