Department of Traumatology and Orthopedic Surgery, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy.
Clin Orthop Surg. 2021 Mar;13(1):10-17. doi: 10.4055/cios20023. Epub 2020 Dec 8.
Current evidence supports the use of cemented hemiarthroplasty for treatment of intracapsular femoral neck fractures since it is associated with a lower risk of implant-related complications. However, many medical centers employ the cementless technique for the frail elderly population because it is faster and has lower cardiovascular risks and perioperative mortality. This observational study reports the outcomes of cementless bipolar hemiarthroplasty for intracapsular femoral neck fractures in patients aged 80 years and older.
A total of 424 patients (female, 77.1%) with a mean age of 86.9 years were operated for intracapsular femoral neck fractures between January 2009 and December 2017. Of those, 66.7% had an American Society of Anaesthesiologists (ASA) score of 3 or more. All operations were performed with the posterolateral surgical approach and all patients received a cementless stem. Intraoperative and perioperative values and in-hospital outcomes were evaluated, and clinical and radiographical follow-up was done at 40 days, 90 days, and when possible between 5 months and 12 months postoperatively. Multivariate analysis was performed to evaluate if there were factors affecting mortality.
The mean operative time was 50 minutes. There were no deaths intraoperatively. Intraoperative periprosthetic fractures occurred in 2.1% of the cases with 66.7% of them fixed through cerclage wires intraoperatively. The median length of hospitalization was 11 days (interquartile range, 8.75-15) and 2.4% of patients died while in hospital after surgery. Approximately 91.5% of patients presented with perioperative anemia. Only 1.9% of the complications were related to the implant, 62.5% of which were dislocations. More than 90% of patients were ambulatory either autonomously or with support at each follow-up assessment. Age, male sex, and higher ASA score were related to increased mortality.
Despite some limitations, this observational study underlines that a cementless femoral stem of modern design can give good clinical outcomes, thus being an appropriate solution especially for the frail elderly.
目前的证据支持使用骨水泥型半髋关节置换术治疗囊内股骨颈骨折，因为它与较低的植入物相关并发症风险相关。然而，许多医疗中心对体弱的老年患者采用非骨水泥技术，因为它速度更快，心血管风险和围手术期死亡率更低。本观察性研究报告了年龄在 80 岁及以上的囊内股骨颈骨折患者采用非骨水泥双极半髋关节置换术的结果。
2009 年 1 月至 2017 年 12 月期间，共有 424 例（女性 77.1%）年龄在 86.9 岁的患者因囊内股骨颈骨折接受手术。其中 66.7%的患者美国麻醉师协会（ASA）评分在 3 分或以上。所有手术均采用后外侧手术入路，所有患者均接受非骨水泥柄。评估术中及围手术期值和院内结果，并在术后 40 天、90 天和 5 个月至 12 个月进行临床和影像学随访。进行多变量分析，以评估是否有影响死亡率的因素。
平均手术时间为 50 分钟。术中无死亡。术中发生假体周围骨折 2.1%，其中 66.7%通过环扎线固定。中位住院时间为 11 天（四分位距 8.75-15），术后住院期间有 2.4%的患者死亡。约 91.5%的患者围手术期发生贫血。只有 1.9%的并发症与植入物有关，其中 62.5%为脱位。超过 90%的患者在每次随访评估时都能够自主或借助支撑物行走。年龄、男性和更高的 ASA 评分与死亡率增加相关。
尽管存在一些局限性，但本观察性研究强调，现代设计的非骨水泥股骨柄可以获得良好的临床结果，因此特别适合体弱的老年患者。
