从传统髋臼杯转换为双动髋臼杯后，股骨颈骨折全髋关节置换术中脱位率降低。
Lower dislocation rate in total hip arthroplasty for femoral neck fracture after transition from a conventional cup to a dual mobility cup.
作者信息
Pejic Ana, Mukka Sebastian, Sward Per, Jobory Ammar, Leonardsson Olof
机构信息
Department of Orthopaedics, Blekinge Hospital, Karlskrona, Sweden; Departments of Orthopedics and Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
Department of Surgical and Perioperative Science (Orthopaedics), Umeå University, Sweden.
出版信息
Injury. 2025 Aug;56(8):112539. doi: 10.1016/j.injury.2025.112539. Epub 2025 Jun 20.
INTRODUCTION
Dislocation is a major complication of total hip arthroplasty (THA) for femoral neck fractures (FNFs). Dual mobility cups (DMCs) are in clinical practice for patients at risk of dislocation in primary-and revision arthroplasty. This study investigated whether changing routines from conventional THA (cTHA) to DMC for fracture patients at our orthopaedic unit resulted in a reduced dislocation rate.
MATERIAL AND METHODS
In 2016, a change was implemented in our department's standard procedure for patients undergoing THA for FNFs, replacing the cTHA with DMC as the preferred acetabular component. A search in the medical records retrospectively identified all patients with acute FNFs treated with THA from 2010 through 2021. Age, sex, American Society of Anesthesiologists (ASA) score 3-4 vs. 1-2, surgeon experience (hip specialist vs. orthopaedic surgeon) and cup type cTHA vs. DMC were included in the multivariable Cox regression analysis.
RESULTS
After screening and exclusion, 219 patients were included in the analysis: 108 patients treated with cTHA and 111 patients with DMC. The groups did not statistically significantly differ in age, sex and ASA score. There was, furthermore, no statistically significant difference in waiting time to surgery or length of surgery between groups. The follow-up time was longer for cTHA due to a change of routines. Fracture surgery with DMC was predominately performed by a specialized hip surgeon whereas cTHA was predominately performed by a general orthopaedic surgeon. 24 (11 %) patients had at least one dislocation during the study period: 22 in the cTHA group and 2 in the DMC group (p < 0.001). The multivariable Cox regression analysis revealed an independent association between the risk of dislocation and the use of cTHA (compared to DMC) with a hazard ratio (HR) of 14.16 (95 % confidence interval [CI] 2.80-71.75).
CONCLUSION
After implementing a DMC, the occurrence of dislocations in patients with FNFs who underwent THA decreased.
引言
对于股骨颈骨折（FNF）患者，全髋关节置换术（THA）后脱位是一种主要并发症。双动髋臼杯（DMC）在初次和翻修关节置换术中用于有脱位风险的患者的临床实践中。本研究调查了在我们骨科单元，将骨折患者的常规全髋关节置换术（cTHA）改为使用DMC是否会降低脱位率。
材料与方法
2016年，我们科室对接受THA治疗FNF的患者的标准程序进行了改变，用DMC取代cTHA作为首选髋臼组件。通过回顾性检索病历确定了2010年至2021年期间所有接受THA治疗急性FNF的患者。年龄、性别、美国麻醉医师协会（ASA）评分3 - 4与1 - 2、外科医生经验（髋关节专科医生与骨科医生）以及髋臼杯类型cTHA与DMC被纳入多变量Cox回归分析。
结果
经过筛选和排除，219例患者被纳入分析：108例接受cTHA治疗，111例接受DMC治疗。两组在年龄、性别和ASA评分方面无统计学显著差异。此外，两组在手术等待时间或手术时长方面也无统计学显著差异。由于程序改变，cTHA组的随访时间更长。使用DMC的骨折手术主要由专业髋关节外科医生进行，而cTHA主要由普通骨科医生进行。24例（11%）患者在研究期间至少发生一次脱位：cTHA组22例，DMC组2例（p < 0.001）。多变量Cox回归分析显示，脱位风险与使用cTHA（与DMC相比）之间存在独立关联，风险比（HR）为14.16（95%置信区间[CI] 2.80 - 71.75）。
结论
采用DMC后，接受THA的FNF患者脱位发生率降低。
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