Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Int Orthop. 2019 Nov;43(11):2637-2647. doi: 10.1007/s00264-019-04327-9. Epub 2019 Apr 9.
Cementless hemiarthroplasty is a widely used treatment for femoral neck fractures. Intra-operative femoral fracture occasionally occurs during the procedure, and the use of cerclage wire has been proposed to stabilize both the prosthesis and the bone. This study aimed to investigate the outcomes of cerclage wiring to manage intra-operative fractures occurring during cementless hemiarthroplasty in older patients with a femoral neck fracture.
Medical records and radiographs of older patients with femoral neck fractures who underwent hemiarthroplasty during 2009 to 2015 were retrospectively reviewed. Patients who received cerclage wiring were matched with a demographically matched control group that did not. Patients were followed for at least 12 months. Functional outcomes and health-related quality of life were evaluated by determining the distance of distal stem migration, Barthel Index, EuroQol-visual analog scale (VAS), and pain-VAS.
Eighty-one patients were included, comprising 27 study group and 54 control group patients. A tapered wedge-shaped femoral prosthesis was implanted in all cases. No significant differences in distance of distal stem migration or rate of stem subsidence > 2 mm were observed between the case and control groups (subsidence rate 11.1 vs. 14.8%, respectively). There was also no significant difference in functional outcomes between groups.
Our results revealed a low mean distance of distal stem migration and a low subsidence rate. Functional outcomes and quality of life were similar between the two groups. Cerclage wiring technique is safe, and it should be routinely performed when intra-operative femoral fracture occurs during cementless hemiarthroplasty.
非骨水泥半髋关节置换术是治疗股骨颈骨折的常用方法。术中股骨骨折偶尔会发生，使用环扎线已被提议用于稳定假体和骨骼。本研究旨在探讨在老年股骨颈骨折患者行非骨水泥半髋关节置换术中发生骨折时使用环扎线固定的效果。
回顾性分析 2009 年至 2015 年期间接受半髋关节置换术的老年股骨颈骨折患者的病历和 X 线片。接受环扎线固定的患者与未接受环扎线固定的匹配对照组患者进行匹配。所有患者均随访至少 12 个月。通过测量远端柄迁移距离、Barthel 指数、EuroQol 视觉模拟量表（VAS）和疼痛 VAS 来评估功能结果和健康相关生活质量。
共纳入 81 例患者，其中 27 例为研究组，54 例为对照组。所有患者均植入锥形楔形股骨假体。在研究组和对照组之间，远端柄迁移距离或柄下沉>2mm 的发生率均无显著差异（下沉率分别为 11.1%和 14.8%）。两组间的功能结果也无显著差异。
我们的结果显示，平均远端柄迁移距离较低，下沉率较低。两组的功能结果和生活质量相似。环扎线技术是安全的，在非骨水泥半髋关节置换术中发生术中股骨骨折时应常规使用。
