骨水泥型髋关节翻修杯在老年骨质疏松性髋臼骨折中的初次固定
Cementless hip revision cup for the primary fixation of osteoporotic acetabular fractures in geriatric patients.
机构信息
Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany.
Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany.
出版信息
Orthop Traumatol Surg Res. 2021 Feb;107(1):102745. doi: 10.1016/j.otsr.2020.102745. Epub 2020 Dec 14.
BACKGROUND
Elderly patients suffering from hip fractures are usually not able to fulfil postoperative weight-bearing restrictions. Therefore, the operative fixation construct has to be as stable as possible. Aim of the present study was to determine (1) whether a therapeutic advantage could be achieved when using hip arthroplasty to treat acetabular fractures in geriatric patients; (2) whether an acetabular revision cup would be suitable for achieving fast postoperative mobilization and full weight-bearing; and (3) when a treatment with an uncemented hip revision cup for the primary fixation of osteoporotic acetabular fractures in geriatric patients is indicated.
MATERIALS AND METHODS
The functional outcome of THA using a reconstruction cup for an acetabular fracture was evaluated in ten patients using standardized scoring instruments. In addition, an analysis of the preexisting literature referring to total hip replacement in geriatric acetabular fractures was conducted and an algorithm for standardizing the treatment approach for geriatric patients with acetabular fractures was developed.
RESULTS
The mean EQ-5D-3L quality of life score 0.7. The mean VAS Score was 58.2. The average Barthel Index was 80.0 points [range: 0-100]. The mean HHS was 72.0 points, while the MHH Score yielded an average of 63.4 points. The average AP Score was 7.5. The literature analysis showed that total hip arthroplasty could be a feasible option for geriatric acetabular fractures.
CONCLUSION
Primary hip arthroplasty using uncemented revision cup fixed with angular stable screws showed good results and is a feasible treatment option of acetabular fractures in geriatric patients. The approach is especially beneficial in patients with poor bone stock and allows postoperative full weight-bearing. The presented treatment algorithm could be a useful tool for identifying the most appropriate treatment option.
LEVEL OF EVIDENCE
IIb.
背景
患有髋部骨折的老年患者通常无法满足术后负重限制。因此，手术固定结构必须尽可能稳定。本研究的目的是确定：(1) 对于老年患者的髋臼骨折，使用髋关节置换术是否可以获得治疗优势；(2) 髋臼翻修杯是否适合实现快速术后活动和完全负重；以及 (3) 对于骨质疏松性髋臼骨折的老年患者，初次固定时使用非骨水泥髋关节翻修杯是否有治疗意义。
材料和方法
使用标准化评分工具评估了 10 例使用重建杯治疗髋臼骨折的 THA 的功能结果。此外，还对涉及老年髋臼骨折全髋关节置换的现有文献进行了分析，并制定了用于标准化老年髋臼骨折患者治疗方法的算法。
结果
平均 EQ-5D-3L 生活质量评分为 0.7。平均 VAS 评分为 58.2。平均巴氏指数为 80.0 分[范围：0-100]。平均 HHS 为 72.0 分，而 MHH 评分为 63.4 分。平均 AP 评分为 7.5。文献分析表明，全髋关节置换术对于老年髋臼骨折是可行的选择。
结论
使用带角度稳定螺钉固定的非骨水泥翻修杯进行初次髋关节置换术显示出良好的效果，是老年患者髋臼骨折的一种可行治疗选择。该方法特别适用于骨量差的患者，并允许术后完全负重。所提出的治疗算法可以作为确定最合适治疗方案的有用工具。
证据水平
IIb。
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