Kabelitz Method, Fritz Yannick, Grueninger Patrick, Meier Christoph, Fries Patrick, Dietrich Michael
Department for Surgery, City Hospital Waid Zurich, Zurich, Switzerland.
Department for Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
Geriatr Orthop Surg Rehabil. 2018 Mar 29;9:2151459318765381. doi: 10.1177/2151459318765381. eCollection 2018.
Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems.
We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later.
We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B and 2 Vancouver A) were treated conservatively. One periprosthetic femoral fracture (Vancouver B) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented.
Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons.
Level III, Therapeutic study.
在治疗高龄患者骨折时，无骨水泥型股骨柄在半髋关节置换术（HA）中的下沉以及骨折率增加一直是骨科医生关注的问题。此外，骨水泥植入综合征可能导致围手术期心脏或肺部并发症，尤其是在老年患者中，进而导致发病和死亡。本研究旨在分析一组接受无骨水泥柄治疗的高龄患者中可能出现的下沉和术中骨折情况。
我们回顾性分析了一组年龄≥90岁、采用无骨水泥HA和前路微创方法治疗股骨颈骨折的连续患者队列。术后立即允许完全负重。术后即刻和6周后检查骨盆X线片以评估下沉情况。
2010年1月至2016年3月，我们通过HA治疗了109例患者（74%为女性；平均年龄93岁；范围90 - 102岁）。30天死亡率为16%，发病率为47%。有11例（12%）术中骨折：8例（温哥华B型）在初次手术期间必须立即处理，而3例（1例温哥华B型和2例温哥华A型）采用保守治疗。随访期间记录到1例假体周围股骨骨折（温哥华B型）。在17例患者中，记录到下沉>2.0 mm（中位数3.9 mm；范围2.5 - 9.0 mm）。
在这个接受无骨水泥柄治疗且未出现假体周围骨折的高龄队列中，早期下沉率较低，但术中假体周围骨折的风险较高。在骨质疏松性骨中使用无骨水泥植入物仍然是一种高风险的干预措施，应由经验丰富的外科医生进行。
三级，治疗性研究。
