人工关节置换术与非人工关节置换术治疗移位型股骨颈骨折：一项为期两年随访的随机对照试验
Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A randomized controlled trial with two years follow-up.
作者信息
Movrin Igor
机构信息
Department of Traumatology, University Medical Centre Maribor, Maribor, Slovenia.
出版信息
Acta Orthop Traumatol Turc. 2020 Jan;54(1):83-88. doi: 10.5152/j.aott.2020.01.432.
OBJECTIVE
The aim of this prospective randomized trial was to compare cemented (CHA) and uncemented bipolar hemiarthroplasty (UCH) in patients with femoral neck fractures (FNF).
METHODS
The study included 158 patients aged ≥76 years who underwent bipolar HA for displaced FNF. Patients were randomized in two groups: the cemented group (CHA, n=79) was treated with cement and the uncemented group (UCH, n=79) without cement. The groups were compared for operating time, blood loss and peroperative morbidity and mortality rates.
RESULTS
Both the CHA and the UCH group did not differ significantly in terms of age (86±5 vs. 84±4 years), sex (58.3% male vs. 60.7% female), and comorbidities (p=0.49). The CHA group had a significantly longer operating time (p=0.038) and a greater intraoperative blood loss (p=0.024). In the CHA group there were 8 (10.1%) events of intraoperative drop in the oxygen saturation (SaO2), whereas no such events were noted in the UCH group (p=0.009). Despite no significant difference between these two groups, we found that the CHA group was associated with a higher early postoperative mortality (8.8% in the CHA group versus 3.8% in the UCH group, p=0.009). Intraoperative fracture occurred in two patients (2.5%) of the UCH group. Over a 2-year follow-up period there were no significant differences between the groups regarding the rate of dislocation (p=0.56) or rate of postoperative periprosthetic fracture (p=0.56). There was a trend towards a better postoperative functional recovery at 6 week for the CHA group (77.1±13.1 versus 71.3±16.3), although the mean Harris Hip Score (HHS) at the end of 2 years was comparable (p=0.55).
CONCLUSION
Both CHA and UCH are acceptable methods for treating displaced femoral neck fractures. However, based on our results perioperative cardiovascular disturbances are less frequent and resulting in a potential lower early mortality with UCH. Therefore, UCH is particularly appropriate for elderly patients with pre-existing cardiovascular comorbidities.
LEVEL OF EVIDENCE
Level II, Randomized Controlled Trial.
目的
本前瞻性随机试验旨在比较股骨颈骨折（FNF）患者的骨水泥型（CHA）和非骨水泥型双极半髋关节置换术（UCH）。
方法
本研究纳入了158例年龄≥76岁、因移位性FNF接受双极半髋关节置换术的患者。患者被随机分为两组：骨水泥组（CHA，n = 79）采用骨水泥治疗，非骨水泥组（UCH，n = 79）不使用骨水泥。比较两组的手术时间、失血量以及手术中的发病率和死亡率。
结果
CHA组和UCH组在年龄（86±5岁 vs. 84±4岁）、性别（男性58.3% vs. 女性60.7%）和合并症方面（p = 0.49）差异均无统计学意义。CHA组的手术时间明显更长（p = 0.038），术中失血量更多（p = 0.024）。CHA组有8例（10.1%）术中氧饱和度（SaO2）下降事件，而UCH组未观察到此类事件（p = 0.009）。尽管两组之间无显著差异，但我们发现CHA组术后早期死亡率更高（CHA组为8.8%，UCH组为3.8%，p = 0.009）。UCH组有2例患者（2.5%）术中发生骨折。在2年的随访期内，两组在脱位率（p = 0.56）或术后假体周围骨折率（p = 0.56）方面无显著差异。虽然2年末的平均Harris髋关节评分（HHS）相当（p = 0.55），但CHA组在术后6周时功能恢复有更好的趋势（77.1±13.1 vs. 71.3±16.3）。
结论
CHA和UCH都是治疗移位性股骨颈骨折的可接受方法。然而，根据我们的结果，UCH围手术期心血管干扰较少，早期死亡率可能更低。因此，UCH特别适合有心血管合并症的老年患者。
证据水平
II级，随机对照试验。
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