Grammatopoulos G, Wilson H A, Kendrick B J L, Pulford E C, Lippett J, Deakin M, Andrade A J, Kambouroglou G
Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, OX3 7LD, UK.
Royal Berkshire NHS Foundation Trust, London Road, Reading, Berkshire RG1 5AN, UK.
Bone Joint J. 2015 Jan;97-B(1):94-9. doi: 10.1302/0301-620X.97B1.34138.
National Institute of Clinical Excellence guidelines state that cemented stems with an Orthopaedic Data Evaluation Panel (ODEP) rating of > 3B should be used for hemiarthroplasty when treating an intracapsular fracture of the femoral neck. These recommendations are based on studies in which most, if not all stems, did not hold such a rating. This case-control study compared the outcome of hemiarthroplasty using a cemented (Exeter) or uncemented (Corail) femoral stem. These are the two prostheses most commonly used in hip arthroplasty in the UK. Data were obtained from two centres; most patients had undergone hemiarthroplasty using a cemented Exeter stem (n = 292/412). Patients were matched for all factors that have been shown to influence mortality after an intracapsular fracture of the neck of the femur. Outcome measures included: complications, re-operations and mortality rates at two, seven, 30 and 365 days post-operatively. Comparable outcomes for the two stems were seen. There were more intra-operative complications in the uncemented group (13% vs 0%), but the cemented group had a greater mortality in the early post-operative period (n = 6). There was no overall difference in the rate of re-operation (5%) or death (365 days: 26%) between the two groups at any time post-operatively. This study therefore supports the use of both cemented and uncemented stems of proven design, with an ODEP rating of 10A, in patients with an intracapsular fracture of the neck of the femur.
英国国家临床优化研究所（National Institute of Clinical Excellence）指南指出，在治疗股骨颈囊内骨折进行半髋关节置换术时，应使用骨科数据评估小组（ODEP）评级大于3B的骨水泥型股骨柄。这些建议是基于一些研究得出的，在这些研究中，即使不是所有的股骨柄，大多数也未达到这样的评级。这项病例对照研究比较了使用骨水泥型（埃克塞特，Exeter）或非骨水泥型（科雷尔，Corail）股骨柄进行半髋关节置换术的结果。这是英国髋关节置换术中最常用的两种假体。数据来自两个中心；大多数患者接受了使用骨水泥型埃克塞特股骨柄的半髋关节置换术（n = 292/412）。对所有已证明会影响股骨颈囊内骨折后死亡率的因素进行了患者匹配。结果指标包括：术后2天、7天、30天和365天的并发症、再次手术和死亡率。两种股骨柄的结果相当。非骨水泥组术中并发症更多（13% 对0%），但骨水泥组术后早期死亡率更高（n = 6）。两组在术后任何时间的再次手术率（5%）或死亡率（365天：26%）均无总体差异。因此，本研究支持在股骨颈囊内骨折患者中使用经证实设计的ODEP评级为10A的骨水泥型和非骨水泥型股骨柄。
