Vidovic Dinko, Matejcic Aljosa, Punda Marija, Ivica Mihovil, Tomljenovic Mladen, Bekavac-Beslin Miroslav, Mijic August, Bakota Bore
University Hospital "Sisters of Mercy", Department of Trauma and Orthopaedic Reconstructive Surgery, Vinogradska cesta 29, 10000 Zagreb, Croatia.
Injury. 2013 Sep;44 Suppl 3:S62-6. doi: 10.1016/S0020-1383(13)70201-8.
The aim of this prospective randomized clinical study was to evaluate the magnitude of bone mineral changes as well as the clinical results after cemented and cementless haemiarthroplasty (HA) for femoral neck fracture. The study was comprised of 60 patients (mean age 85.2 years); 30 of them underwent cemented HA and 30 cementless HA. All patients underwent osteodensitometry for the purpose of Bone Mineral Density (BMD) evaluation. BMD was measured with dual-energy X-ray absorptiometry test (DEXA scans), which was scheduled at 1 month, 6 months and 1 year after surgery. BMD was evaluated at each of the seven Gruen zones. Harris Hip Score (HHS) at 3 months, 6 months and 12 months was used for evaluation of functional outcome. No difference was found between the two groups of patients in terms hospital stay, morbidity and mortality. The procedure took longer time in group A (cemented HA) compared to group B (cementless HA) (79.03 ± 3.59 vs 68.02 ± 5.97 minutes; p = 0.00). The Harris hip score averaged 76.97 ± 7.49 one year after surgery. At each follow - up examination the HHS was significantly higher in patients with cemented HA. We noted a trend of less intensive BMD reduction in all Gruen zones in group A compared to group B. However, the difference in BMD reduction between these two groups was significant only in zones 2, 3 and 4. Our results support the view that cemented hemiarthroplasty should be used for the management of displaced femoral neck fractures providing better functional outcomes and lower periprosthetic bone loss.
这项前瞻性随机临床研究的目的是评估股骨颈骨折行骨水泥型和非骨水泥型半髋关节置换术（HA）后的骨矿物质变化程度以及临床结果。该研究纳入了60例患者（平均年龄85.2岁）；其中30例行骨水泥型HA，30例行非骨水泥型HA。所有患者均接受骨密度测定以评估骨矿物质密度（BMD）。采用双能X线吸收法检测（DEXA扫描）测量BMD，分别在术后1个月、6个月和1年进行。在Gruen七个区域的每一个区域评估BMD。采用术后3个月、6个月和12个月的Harris髋关节评分（HHS）评估功能结果。两组患者在住院时间、发病率和死亡率方面均未发现差异。与B组（非骨水泥型HA）相比，A组（骨水泥型HA）的手术时间更长（79.03±3.59分钟 vs 68.02±5.97分钟；p = 0.00）。术后1年Harris髋关节评分平均为76.97±7.49。在每次随访检查中，骨水泥型HA患者的HHS显著更高。我们注意到，与B组相比，A组所有Gruen区域的BMD降低趋势较轻。然而，两组之间BMD降低的差异仅在区域2、3和4显著。我们的结果支持以下观点，即骨水泥型半髋关节置换术应用于移位型股骨颈骨折的治疗，可提供更好的功能结果和更低的假体周围骨丢失。
