股骨颈骨折行非骨水泥型全髋关节置换术或半髋关节置换术后股骨柄下沉与通过多氏（Dorr）评分评估的局部股骨骨质及皮质厚度指数无关。
Femoral stem subsidence after uncemented total or hemiarthroplasty for femoral neck fractures does not correlate with local femoral bone quality evaluated by Dorr and cortical thickness index.
作者信息
Badoux Rahel, Waltenspül Manuel, Dietrich Michael, Kabelitz Method
机构信息
Department of Orthopaedics, Hand- and Trauma Surgery, Stadtspital Zürich, Zürich, Switzerland.
出版信息
Arch Orthop Trauma Surg. 2025 May 21;145(1):307. doi: 10.1007/s00402-025-05928-3.
INTRODUCTION
The increase in femoral neck fractures in elderly individuals is primarily attributable to reduced bone mineral density (BMD). Dual-energy X-ray absorptiometry (DEXA), has been demonstrated to be a reliable bone mineral density (BMD) estimate. Femoral cortical thickness index (CTI), and Dorr classification are reliable assessment methods of the femoral cortical thickness. Patients with low BMD, low CTI or Dorr C who undergo uncemented total hip arthroplasty (THA) or hemiarthroplasty (HA) are at an increased risk of early femoral stem subsidence (FSS). Dual-energy X-ray absorptiometry (DEXA), femoral cortical thickness index (CTI), and Dorr classification have been demonstrated to be reliable bone mineral density (BMD) estimates. Patients with low BMD who undergo uncemented total hip arthroplasty (THA) or hemiarthroplasty (HA) are at an increased risk of early femoral stem subsidence (FSS). The objective of this study was to investigate the relationship between CTI, Dorr classification, and early FSS, hypothesizing that these indicators can predict stem subsidence.
MATERIAL AND METHODS
A retrospective analysis was conducted on patients with femoral neck fractures treated by uncemented THA or HA using the direct anterior approach (DAA). Preoperative radiographs were utilized to assess CTI and Dorr classification. Postoperative FSS was the primary outcome measure, with follow-up X-rays averaging 403 days (range 38-3371). The canal fill ratio (CFR) was observed at four levels postoperatively. A subsequent statistical analysis was conducted to examine the correlation between CTI, Dorr classification, CFR, BMI, age, and FSS.
RESULTS
The study's sample population included 64 patients (20 male, 44 female) with a mean age of 73 ± 9 years, who were treated between June 2020 and February 2024. The mean femoral CTI was 0.51 ± 0.08 on the fractured side and 0.54 ± 0.06 on the contralateral unaffected side. The mean FSS was 1.02 ± 1.49 mm. A subsidence of at least 5 mm was identified in a mere two patients, both of whom were classified as Dorr B. A modest correlation (r = 0.27) was noted between FSS and CRF 2.
CONCLUSION
Neither decreased BMD nor cortical thickness correlated with femoral stem subsidence.
LEVEL OF EVIDENCE
Level III, Therapeutic study.
引言
老年人群股骨颈骨折的增加主要归因于骨矿物质密度（BMD）降低。双能X线吸收法（DEXA）已被证明是一种可靠的骨矿物质密度（BMD）评估方法。股骨皮质厚度指数（CTI）和多尔分类是股骨皮质厚度的可靠评估方法。接受非骨水泥型全髋关节置换术（THA）或半髋关节置换术（HA）的低骨密度、低CTI或多尔C型患者早期股骨柄下沉（FSS）风险增加。双能X线吸收法（DEXA）、股骨皮质厚度指数（CTI）和多尔分类已被证明是可靠的骨矿物质密度（BMD）评估方法。接受非骨水泥型全髋关节置换术（THA）或半髋关节置换术（HA）的低骨密度患者早期股骨柄下沉（FSS）风险增加。本研究的目的是调查CTI、多尔分类与早期FSS之间的关系，假设这些指标可以预测柄下沉。
材料与方法
对采用直接前路（DAA）行非骨水泥型THA或HA治疗的股骨颈骨折患者进行回顾性分析。术前X线片用于评估CTI和多尔分类。术后FSS是主要结局指标，随访X线片平均403天（范围38 - 3371天）。术后在四个层面观察髓腔填充率（CFR）。随后进行统计分析，以检查CTI、多尔分类、CFR、体重指数（BMI）、年龄和FSS之间的相关性。
结果
该研究的样本包括64例患者（20例男性，44例女性），平均年龄73±9岁，于2020年6月至2024年2月期间接受治疗。骨折侧股骨平均CTI为0.51±0.08，对侧未受影响侧为0.54±0.06。平均FSS为1.02±1.49mm。仅两名患者出现至少5mm的下沉，这两名患者均被分类为多尔B型。FSS与CRF 2之间存在适度相关性（r = 0.27）。
结论
骨密度降低和皮质厚度均与股骨柄下沉无关。
证据水平
三级，治疗性研究。
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