Rodriguez-Buitrago Andres, Attum Basem, Cereijo Cesar, Yusi Kurt, Jahangir A Alex, Obremskey William T
Vanderbilt University Medical Center, Nashville, Tennessee.
JBJS Essent Surg Tech. 2019 Apr 10;9(2):e13. doi: 10.2106/JBJS.ST.18.00010. eCollection 2019 Jun 26.
Hemiarthroplasty is a common treatment for femoral neck fractures in the elderly population. The main complications are periprosthetic dislocation and infection, which potentially impact morbidity and quality of life and may contribute to mortality. This procedure can be technically demanding, and adequate closure of the capsule and soft tissue cannot be emphasized enough. One advantage of a bipolar prosthesis is that it can be easily converted to a total hip arthroplasty without replacing the femoral component and with approximately the same complication rates as a revision total hip arthroplasty. Cement should be used when the patient is osteoporotic or has a Dorr type-C canal because there is a significant reduction in risk of fracture. The addition of a collared stem is helpful if there is a crack in the calcar extending from the fracture. The procedure is as follows. (1) The patient is placed in the lateral decubitus position. (2) The surgical site is prepared and draped to above the iliac crest and mid-sacrum. (3) A posterior approach is utilized. (4) The hip is dislocated. (5) A cut is made at the femoral neck. (6) The implant is templated with the femoral head. (7) The femur is broached. (8) The trial implant is placed. (9) The femur is cemented. (10) Trial implants are removed and cement is placed. (11) The final stem implant is placed in 5° to 10° of anteversion. (12) The final head and neck implants are trialed and then placed. (13) Implant position and range of motion are tested. (14) The surgical wound is irrigated. (15) Short external rotators are repaired. The posterior approach, which is often used, is known for increased rates of dislocation. The rate of dislocation can be minimized with repair of the posterior capsule and posterior soft tissue. Proper placement of the implants is of the utmost importance to minimize complications. Other contributing factors that lead to dislocation are implant malpositioning and patient factors.
半髋关节置换术是老年人群股骨颈骨折的常见治疗方法。主要并发症是假体周围脱位和感染,这可能会影响发病率和生活质量,并可能导致死亡。该手术在技术上要求较高,充分闭合关节囊和软组织至关重要。双极假体的一个优点是可以轻松转换为全髋关节置换术,无需更换股骨部件,且并发症发生率与翻修全髋关节置换术大致相同。当患者患有骨质疏松症或为Dorr C型髓腔时应使用骨水泥,因为骨折风险会显著降低。如果股骨距从骨折处延伸出现裂缝,添加带领柄有助于解决问题。手术步骤如下:(1)患者取侧卧位。(2)手术部位消毒铺巾至髂嵴上方和骶骨中部。(3)采用后入路。(4)髋关节脱位。(5)在股骨颈处做切口。(6)用股骨头进行植入物模板测量。(7)扩髓股骨。(8)放置试验性植入物。(9)股骨骨水泥固定。(10)取出试验性植入物并注入骨水泥。(11)最终柄状植入物以前倾5°至10°放置。(12)对最终的头颈植入物进行试验,然后植入。(13)测试植入物位置和活动范围。(14)冲洗手术伤口。(15)修复短外旋肌。常用的后入路因脱位率增加而闻名。通过修复后关节囊和后部软组织可将脱位率降至最低。正确放置植入物对于减少并发症至关重要。导致脱位的其他因素包括植入物位置不当和患者因素。