Department of Surgery, Dalhousie University, Halifax, NS, Canada.
J Arthroplasty. 2020 Dec;35(12):3627-3630. doi: 10.1016/j.arth.2020.07.006. Epub 2020 Jul 7.
The use of cemented fixation for hip arthroplasty for femoral neck fractures has been advocated to limit the postoperative and intraoperative risk of periprosthetic fractures. However, there are concerns with the potential effects of cementing on patient mortality, particularly at the time of cementation.
This study examined the mortality rates of cemented compared to cementless hip arthroplasty fixation in a group of 5883 femoral neck fracture patients from 2001 to 2017. The data were derived from large administrative databases and census data. Confounders were identified and controlled with a multivariate analysis. The data were also stratified into 2 time frames, 2001-2008 and 2009-2017, to determine if there was an effect of more recent improvements in patient care or implant technology.
Cemented fixation had a statistically significant reduction in mortality rates at 30, 90, and 365 days after surgery. There was no difference in mortality in 0, 1, or ≤7 days after discharge or during the admission. The mortality rate decreased but was still significantly increased with cementless fixation when the subjects were grouped from 2001 to 2008 and 2009 to 2017.
Based on this evidence, the cemented fixation of hip arthroplasty should be considered for patients with femoral neck fractures.
髋关节置换术治疗股骨颈骨折时采用骨水泥固定被提倡用于限制术后和术中发生假体周围骨折的风险。然而，人们担心骨水泥固定对患者死亡率的潜在影响，特别是在骨水泥固定时。
本研究对 2001 年至 2017 年间 5883 例股骨颈骨折患者的骨水泥固定与非骨水泥固定髋关节置换术的死亡率进行了比较。这些数据来自大型行政数据库和人口普查数据。采用多变量分析确定并控制混杂因素。还将数据分层为 2001-2008 年和 2009-2017 年两个时间框架，以确定患者护理或植入物技术的最新改进是否有影响。
术后 30、90 和 365 天，骨水泥固定的死亡率有统计学显著降低。出院后 0、1 或≤7 天或住院期间的死亡率没有差异。当将研究对象分为 2001-2008 年和 2009-2017 年两个时间段时，死亡率虽然有所下降，但非骨水泥固定的死亡率仍显著增加。
基于这一证据，髋关节置换术的骨水泥固定应考虑用于股骨颈骨折患者。
