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对于美国麻醉医师协会(ASA)III级股骨颈骨折患者,半髋关节置换术的首选技术应该是什么?骨水泥型还是非骨水泥型?

What should be the preferred choice of hemiarthroplasty technique in American Society of Anesthesiologists (ASA) class III patients with femoral neck fractures? Cemented or cementless.

作者信息

Cicek Hakan, Seyfettinoglu Fırat, Kilicarslan Kasım, Ogur Hasan Ulas, Öztürk Levent, İnkaya Erkan

机构信息

Adana Numune Training and Research Hospital, Orthopaedi and Traumatology Department, Adana, Turkey.

Adana Numune Training and Research Hospital, Orthopaedi and Traumatology Department, Adana, Turkey.

出版信息

Injury. 2015 Aug;46(8):1567-70. doi: 10.1016/j.injury.2015.05.019. Epub 2015 May 14.

Abstract

The hypothetical basis of this trial specifies that hemiarthroplasty applications without cement will prove to be superior to applications with cement in terms of survival, complications, clinical and radiological improvements in the early stages of femoral neck fracture cases, which belongs to the Society of Anesthesiologists (ASA) class III group. Society of Anesthesiologists (ASA) class III elderly patients (minimum 70 years of age), who had undergone surgical interventions for femoral neck fractures were classified into two groups as those undergoing the intervention without cement (Group A) and those undergoing the procedure with cement (Group B), and these were retrospectively evaluated. The patients were followed up for a mean duration of 47.4 and 44.8 months, respectively. Survival in the early stage, duration of stay in the intensive care, intraoperative cardiac indexes, complications, clinical and radiological parameters were the main factors used in the evaluation and comparisons. The mean duration of operation in Group B cases was determined to be statistically significantly longer than that of Group A (p<0.001). The postoperative stay at the intensive care unit in both groups and the rate of mortality for 6 months in Group B were determined to be statistically significantly high (p<0.05). In group B, significant depressive findings were determined in the comparison of the intra-operative pre-and post-cement cardiac indexes. In the clinical assessment, no statistically significant results were obtained, although higher final Harris scores were determined in Group A cases (p=0.581). In the treatment of femoral neck fractures, bipolar hemiarthroplasty applications without cement provide favourable early and short-term results, which are at least as effective as the applications with cement.

摘要

本次试验的假设依据表明,对于美国麻醉医师协会(ASA)III级组的股骨颈骨折病例,在早期的生存率、并发症、临床及影像学改善方面,非骨水泥型半髋关节置换术将被证明优于骨水泥型。将接受股骨颈骨折手术干预的美国麻醉医师协会(ASA)III级老年患者(至少70岁)分为两组,一组接受非骨水泥型干预(A组),另一组接受骨水泥型手术(B组),并进行回顾性评估。患者分别平均随访47.4个月和44.8个月。早期生存率、重症监护停留时间、术中心脏指数、并发症、临床及影像学参数是评估和比较的主要因素。B组病例的平均手术时间在统计学上显著长于A组(p<0.001)。两组在重症监护病房的术后停留时间以及B组6个月的死亡率在统计学上显著较高(p<0.05)。在B组中,术中骨水泥植入前后心脏指数的比较显示出显著的不良结果。在临床评估中,尽管A组病例最终Harris评分较高,但未获得统计学上的显著结果(p=0.581)。在股骨颈骨折的治疗中,非骨水泥型双极半髋关节置换术可提供良好的早期和短期结果,其效果至少与骨水泥型手术一样有效。

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