Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy.
Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy.
Injury. 2024 Sep;55 Suppl 4:111483. doi: 10.1016/j.injury.2024.111483.
The choice between hemiarthroplasty (HA) and total hip arthroplasty (THA) for displaced femoral neck fractures remains debated. There is increasing use in dual mobility cup total hip arthroplasty (DMC-THA) to prevent dislocations in these high-risk patients. Aim of this study is to retrospectively analyze patients treated in a single Center for femoral neck fracture comparing HA and DMC-THA in terms of: functional outcome, rate of complications and mortality.
Between 2020 and 2022, 162 patients were included, 39 male and 123 female, with a mean age of 76 years old. HA were implanted in 82 cases and DMC-THA in 80 cases. INCLUSION CRITERIA WERE: age < 85 years old, American Society of Anesthesiologists (ASA) score below 3, minimum follow-up of 6 months. Overall, 124/162 of patients (77%) were surgically treated within 48 h from admission.
The mean age for DMC-THA group was 74 years old and 78 years old for HA group. The overall mean surgical time was significantly higher in the DMC-THA group (P < 0.001). Mean hemoglobin (Hb) loss was 1.64 g/dl in the HA group and 1.72 g/dl in the DMC-THA group with no differences between the two groups (P = 0.573). There is no difference in survival of patients between the two groups (P = 0.7704). In the HA group, the mean one-month post-operative VAS score was 2.1, while in the DMC-THA group was 0.9. The Harris hip score was significantly better in DMC-THA group (P = 0.035) Dislocation never occured in the overall series. Infection occurred only in one patient with DMC-THA and was treated with debridement. Periprosthetic fracture occurred in 2 cases of DMC-THA both within 1 month from the first surgery; one was treated with revision femoral stem and the second one with fixation.
DMC-THA offer better functional results than HA in elderly patients with femur neck fractures. The mean surgical time was longer in DMC-THA but this did not influence blood loss, time of discharge or one-year mortality. In our series dislocation never occurred in both groups.
对于移位性股骨颈骨折，选择半髋关节置换术（HA）还是全髋关节置换术（THA）仍然存在争议。在这些高风险患者中，双动杯全髋关节置换术（DMC-THA）的应用越来越多，以防止脱位。本研究的目的是回顾性分析在单一中心接受股骨颈骨折治疗的患者，比较 HA 和 DMC-THA 在以下方面的疗效：功能结果、并发症发生率和死亡率。
2020 年至 2022 年，共纳入 162 例患者，其中男性 39 例，女性 123 例，平均年龄 76 岁。82 例患者行 HA 治疗，80 例患者行 DMC-THA 治疗。纳入标准为：年龄<85 岁，美国麻醉医师协会（ASA）评分<3，随访时间至少 6 个月。总体而言，162 例患者中有 124 例（77%）在入院后 48 小时内接受了手术治疗。
DMC-THA 组的平均年龄为 74 岁，HA 组的平均年龄为 78 岁。DMC-THA 组的平均手术时间明显长于 HA 组（P<0.001）。HA 组平均血红蛋白（Hb）丢失量为 1.64g/dl，DMC-THA 组为 1.72g/dl，两组间无差异（P=0.573）。两组患者的生存率无差异（P=0.7704）。HA 组术后 1 个月的平均视觉模拟评分（VAS）为 2.1，而 DMC-THA 组为 0.9。DMC-THA 组的 Harris 髋关节评分明显更好（P=0.035）。在整个系列中，均未发生脱位。DMC-THA 组仅 1 例发生感染，经清创治疗。DMC-THA 组有 2 例发生假体周围骨折，均发生在初次手术后 1 个月内，1 例采用股骨柄翻修，另 1 例采用固定治疗。
对于股骨颈骨折的老年患者，DMC-THA 比 HA 提供更好的功能结果。DMC-THA 的平均手术时间较长，但这并不影响失血量、出院时间或 1 年死亡率。在我们的系列研究中，两组均未发生脱位。
