Ochi Hironori, Baba Tomonori, Homma Yasuhiro, Matsumoto Mikio, Watari Taiji, Ozaki Yu, Kobayashi Hideo, Kaneko Kazuo
Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Department of Orthopedic Surgery, Sanikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo 130-0012, Japan.
SICOT J. 2017;3:56. doi: 10.1051/sicotj/2017048. Epub 2017 Oct 6.
Although total hip arthroplasty (THA) is superior to bipolar hemiarthroplasty (BHA) for displaced femoral neck fracture in terms of hip pain, function and reoperation rate, THA has a higher rate of dislocation. The direct anterior approach (DAA) and a dual mobility cup (DMC) are associated with lower rates of dislocation. The aim of this study was to investigate the outcomes of THA compared with BHA, and in those patients who had a THA we investigated those with a DMC (DMC-THA) and compared them with those had a single conventional cup (Single cup-THA).
A total of 89 patients living independently were included between 2009 and 2015. We assessed patient characteristics, peri- and post-operative outcomes, walking ability and one-year mortality. Adjusted odds ratios (Adjusted ORs) were estimated for decrease of walking ability and one-year mortality using a logistic regression model with adjustment for potential confounders such as age, neuromuscular diseases with weakness, duration of surgery, perioperative blood loss and preoperative walking ability.
BHA (20 patients) versus THA (69 patients): There was no significant difference in the walking ability in either group. Multivariable logistic regression analysis demonstrated a significant association with one-year mortality in both groups [THA Adjusted ORs 0.088 (95% CI 0.0007-0.69); p = 0.020]. Single cup-THA (36 patients) versus DMC-THA (33 patients): The DMC-THA group had significantly greater age and more patients with neuromuscular diseases with weakness compared with the Single cup-THA group. Multivariable logistic regression analysis demonstrated no significant difference in the decrease of walking ability and in the one-year mortality between the groups. There were no post operative dislocations in any group.
THA via the DAA is one of the best treatments for displaced femoral neck fracture with a low risk of dislocation. THA via the DAA with a DMC is a safe and effective treatment for the patients with a high risk of dislocation.
尽管在髋关节疼痛、功能及再次手术率方面，全髋关节置换术（THA）治疗移位型股骨颈骨折优于双极半髋关节置换术（BHA），但THA的脱位率更高。直接前路（DAA）和双动杯（DMC）与较低的脱位率相关。本研究的目的是比较THA与BHA的治疗效果，对于接受THA的患者，我们研究了使用DMC的患者（DMC-THA），并将其与使用单杯传统髋臼杯的患者（单杯-THA）进行比较。
2009年至2015年间共纳入89例独立生活的患者。我们评估了患者特征、围手术期和术后结果、行走能力及1年死亡率。使用逻辑回归模型，对年龄、伴有肌无力的神经肌肉疾病、手术时间、围手术期失血和术前行走能力等潜在混杂因素进行校正，估计行走能力下降和1年死亡率的校正比值比（校正OR）。
BHA组（20例患者）与THA组（69例患者）：两组患者的行走能力无显著差异。多变量逻辑回归分析显示两组患者的1年死亡率均有显著相关性[THA校正OR为0.088（95%CI为0.0007-0.69）；p = 0.020]。单杯-THA组（36例患者）与DMC-THA组（33例患者）：与单杯-THA组相比，DMC-THA组患者年龄显著更大，伴有肌无力的神经肌肉疾病患者更多。多变量逻辑回归分析显示两组患者在行走能力下降和1年死亡率方面无显著差异。所有组均未发生术后脱位。
经DAA的THA是治疗移位型股骨颈骨折脱位风险较低的最佳治疗方法之一。经DAA联合DMC的THA对于脱位风险较高的患者是一种安全有效的治疗方法。
