Murat Mert, Ermutlu Cenk, Unkar Ethem Ayhan, Topalhafızoglu Sertaç, Şenel Ahmet, Öztürkmen Yusuf
Department of Orthopaedic Surgery, Yeniyuzyil University Medical School, Istanbul, Turkey.
Department of Orthopedics and Traumatology, Uludag University Medical School, Bursa, Turkey.
Indian J Orthop. 2020 Jan 31;54(4):454-462. doi: 10.1007/s43465-019-00009-1. eCollection 2020 Jul.
With the advances in medicine, an increasing number of the ageing population are a public health concern in terms of age-related complications. Among them, displaced neck fractures often require surgical intervention or arthroplasty to achieve the mobilization of the elderly and good life quality. The aim of the study is to monitor the changes in bone mineral density (BMD) around the femoral stem and the effects on functional outcomes in patients treated with cementless hemiarthroplasty following femoral neck fracture.
Seventy-one patients aged 70 years or older who were treated with cementless hemiarthroplasty for a displaced femoral neck fracture were prospectively followed for 2 years. The percent change in the periprosthetic BMD in each Gruen zone was compared to the baseline using dual-energy X-ray absorptiometry (DEXA). Demographic factors [age, body mass index (BMI), and sex] that could possibly influence BMD and the clinical outcome were evaluated.
Fifty-one patients were available for the final follow-up. The mean age was 76.5 (range 70-89) years. The mean BMI was 28.9 (range 22.7-37.2). The mean Harris hip score at the final follow-up was 84.3 (range 72-93). There was a significant decrease in BMD in all Gruen zones ( < 0.001), except in zone 3 (R3, = 0.547). The reduction in BMD was highest in the calcar and the greater trochanter region. The femur diaphysis was relatively spared, with zone 3 showing no significant bone mineral loss. The age and BMI of the patients were not correlated with the postoperative change in BMD in any of the Gruen zones. The degree of reduction in bone density was not correlated with the clinical outcome.
Cementless hemiarthroplasty for the treatment of femoral neck fracture in elderly patients achieves a good clinical outcome despite significant bone loss around the femoral stem. The reduction in BMD is more pronounced in the metaphyseal region.
随着医学的进步，越来越多的老年人口因年龄相关并发症成为公共卫生问题。其中，移位型股骨颈骨折通常需要手术干预或关节置换术，以实现老年人的活动能力和良好的生活质量。本研究的目的是监测股骨颈骨折后行非骨水泥半髋关节置换术患者股骨柄周围骨密度（BMD）的变化及其对功能结局的影响。
对71例年龄在70岁及以上、因移位型股骨颈骨折接受非骨水泥半髋关节置换术的患者进行了为期2年的前瞻性随访。使用双能X线吸收法（DEXA）将每个Gruen区假体周围BMD的变化百分比与基线进行比较。评估了可能影响BMD和临床结局的人口统计学因素[年龄、体重指数（BMI）和性别]。
51例患者完成了最终随访。平均年龄为76.5岁（范围70 - 89岁）。平均BMI为28.9（范围22.7 - 37.2）。最终随访时的平均Harris髋关节评分是84.3（范围72 - 93）。除3区（R3，P = 0.547）外，所有Gruen区的BMD均显著下降（P < 0.001）。骨密度降低在股骨距和大转子区域最为明显。股骨干相对未受影响，3区未显示明显的骨量丢失。患者的年龄和BMI与任何Gruen区术后BMD的变化均无相关性。骨密度降低程度与临床结局无关。
老年患者股骨颈骨折行非骨水泥半髋关节置换术尽管股骨柄周围有明显骨量丢失，但仍能取得良好的临床结局。干骺端区域的BMD降低更为明显。
