Chen Mengcun, Wang Jinlong, Cheema Adnan N, Yang Shuhua, Liu Xianzhe
Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Orthopaedic Surgery, Mayo Clinic, 200 First St NW, Rochester, MN, 55901, USA.
Arthroplasty. 2022 Nov 5;4(1):48. doi: 10.1186/s42836-022-00151-6.
Primary hemiarthroplasty is gaining popularity for the treatment of unstable intertrochanteric fractures in geriatric patients with severe osteoporosis. This study evaluated early clinical and radiographic outcomes by using a bone-conserving revision stem for unstable intertrochanteric fractures in the geriatric osteoporotic population.
A retrospective study involving 31 patients with unstable intertrochanteric fractures was conducted. The patients were aged 82.1 years on average. All patients underwent primary hemiarthroplasty using bone-conserving, fully porous-coated revision stem. The operative time, intraoperative blood loss, length of hospitalization, and need for blood transfusion were noted during the hospital stay. Postoperative complications, including dislocations, deep venous thrombosis, infections, peri-prosthetic fractures, and frontal thigh pain were also recorded. Koval's category was used to quantify activity level, and Harris hip score (HHS) was used for functional assessment. Radiographic outcomes, including osteolysis, bone ingrowth, subsidence of the femoral component, lower limb length discrepancy, and heterotopic ossification, were collected at each follow-up.
The 31 patients were followed for an average time of 23 months postoperatively. The average operative time lasted for 74.2 min, while the mean intraoperative blood loss was 200.1 ml, with an average hemoglobin decrease of 11.1 g/L after the procedure. The mean visual analog scale (VAS) score for pain dropped from 7.4 preoperatively to 2.4 at the 4-week follow-up. At the latest follow-up, the mean Harris hip score was 82.1, and the VAS was 1.7. No intraoperative or postoperative peri-prosthetic fractures were noted. Postoperative complications included one case of thrombosis formation in the posterior tibial vein and one case of congestive heart failure. Both patients were discharged uneventfully after treatment. Radiographically, none of the hips had evidence of stem loosening or osteolysis. Within the follow-up period of 23 months, the mortality rate was 3.2% (1/31), and no revision surgeries were required.
Primary hemiarthroplasty using a bone-conserving, cementless revision stem could serve as a reliable alternative for the treatment of unstable intertrochanteric fractures in the geriatric population with osteoporosis.
对于患有严重骨质疏松症的老年患者，一期半髋关节置换术在治疗不稳定型股骨粗隆间骨折方面越来越受到欢迎。本研究通过使用一种保留骨质的翻修柄治疗老年骨质疏松人群的不稳定型股骨粗隆间骨折，评估其早期临床和影像学结果。
进行了一项回顾性研究，纳入31例不稳定型股骨粗隆间骨折患者。患者平均年龄82.1岁。所有患者均采用保留骨质、全多孔涂层的翻修柄进行一期半髋关节置换术。住院期间记录手术时间、术中出血量、住院时间和输血需求。还记录术后并发症，包括脱位、深静脉血栓形成、感染、假体周围骨折和大腿前侧疼痛。采用Koval分类法量化活动水平，使用Harris髋关节评分（HHS）进行功能评估。每次随访时收集影像学结果，包括骨溶解、骨长入、股骨假体下沉、下肢长度差异和异位骨化。
31例患者术后平均随访23个月。平均手术时间为74.2分钟，术中平均出血量为200.1毫升，术后平均血红蛋白下降11.1克/升。疼痛的平均视觉模拟量表（VAS）评分从术前的7.4降至随访4周时的2.4。在最近一次随访时，平均Harris髋关节评分为82.1，VAS评分为1.7。未发现术中或术后假体周围骨折。术后并发症包括1例胫后静脉血栓形成和1例充血性心力衰竭。两名患者经治疗后均顺利出院。影像学检查显示，所有髋关节均无柄松动或骨溶解迹象。在23个月的随访期内，死亡率为3.2%（1/31），无需翻修手术。
使用保留骨质的非骨水泥翻修柄进行一期半髋关节置换术可作为治疗老年骨质疏松人群不稳定型股骨粗隆间骨折的可靠替代方法。
