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使用骨水泥双动髋臼杯置入全多孔多角度锁定螺钉的多孔髋臼杯进行全髋关节置换术治疗老年体弱患者的髋臼骨折

Total Hip Arthroplasty with Cemented Dual Mobility Cup into a Fully Porous Multihole Cup with Variable Angle Locking Screws for Acetabular Fractures in the Frail Elderly.

作者信息

van den Broek Mathias, Govaers Kris

机构信息

Department of Orthopaedic Surgery, az Sint-Blasius, Dendermonde, Belgium.

出版信息

Hip Pelvis. 2023 Mar;35(1):54-61. doi: 10.5371/hp.2023.35.1.54. Epub 2023 Mar 6.

Abstract

PURPOSE

The purpose was to examine the clinical and radiological outcomes after surgical treatment of acetabular fractures with total hip arthroplasty with a dual mobility cup cemented into a porous multihole cup in the population of frail elderly patients.

MATERIALS AND METHODS

A retrospective review of 16 patients who underwent surgery (mean age, 76.7 years) with a mean follow-up period of 36.9 months was conducted. Following surgery, patients underwent postoperative follow-up at six weeks, three, six, and 12 months and clinical and radiological examinations were performed.

RESULTS

Classification of fractures was based on the Letournel classification. Following surgery, all patients were allowed weight-bearing as tolerated immediately postoperative. Fourteen patients showed maintenance of preoperative mobility status at one year. The mean Harris hip score was 64.8 (range, 34.7-82.8) and 80.0 (range, 60.8-93.8) at three months and one year, respectively. The mortality rate was 12.5% at one year (2/16). Complications included heterotopic ossification (2/16), deep venous thrombosis (1/16), heamatoma (1/16), and femoral revision due to a Vancouver B2 fracture (1/16). No case of deep infection, dislocation, or implant loosening was reported.

CONCLUSION

Total hip arthroplasty using a dual mobility cup cemented into a porous multihole cup with locking screws resulted in a stable construct with a capacity for immediate weight-bearing as tolerated with rapid relief of pain. The findings of this study suggest that this procedure can be regarded as a safe method that has shown promising clinical and radiological outcomes for treatment of patients with medical frailty.

摘要

目的

本研究旨在探讨在体弱老年患者群体中,采用全髋关节置换术治疗髋臼骨折,并将双动杯骨水泥固定于多孔杯中的临床及影像学结果。

材料与方法

对16例行手术治疗(平均年龄76.7岁)且平均随访36.9个月的患者进行回顾性研究。术后,患者在六周、三个月、六个月及十二个月时接受术后随访,并进行临床及影像学检查。

结果

骨折分类依据Letournel分类法。术后,所有患者均在术后即刻根据耐受情况允许负重。14例患者在术后一年保持了术前的活动状态。术后三个月及一年时,Harris髋关节评分的平均值分别为64.8(范围34.7 - 82.8)和80.0(范围60.8 - 93.8)。一年时的死亡率为12.5%(2/16)。并发症包括异位骨化(2/16)、深静脉血栓形成(1/16)、血肿(1/16)以及因温哥华B2型骨折进行的股骨翻修(1/16)。未报告深部感染、脱位或植入物松动的病例。

结论

采用双动杯骨水泥固定于多孔杯并使用锁定螺钉的全髋关节置换术产生了一个稳定的结构,能够在术后即刻根据耐受情况允许负重,并能迅速缓解疼痛。本研究结果表明,该手术方法可被视为一种安全的方法,在治疗体弱患者方面已显示出良好的临床及影像学结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf7a/10020729/414d52a642ce/hp-35-54-g001.jpg

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