Pongkunakorn Anuwat, Teerasukakul Siravat, Tahwang Siripong, Prayatkul Wongsapat
Lampang Hospital, Lampang, Thailand.
Arch Orthop Trauma Surg. 2025 Jul 15;145(1):374. doi: 10.1007/s00402-025-05976-9.
Restoring femoral offset (FO) and equalizing leg lengths are essential for optimal outcomes and preventing leg length discrepancy (LLD) in bipolar hemiarthroplasty (BHA) for femoral neck fractures (FNF) in elderly patients. However, evidence on the benefits of digital templating remains limited. This study evaluates the accuracy of a smartphone-based digital templating method for equalizing leg length and FO in BHA compared to the conventional intraoperative method.
A retrospective cohort study was conducted on 210 patients aged ≥ 60 years with FNF who underwent BHA between June 2018 and May 2023. The templating group (n = 70) used preoperative digital templating with Keynote presentation software on an iPhone, incorporating femoral prosthesis templates. The conventional group (n = 140) relied on intraoperative visual estimation, palpation, and the shuck test. Postoperative LLD and FO differences were assessed radiographically.
The mean patient age was 74.9 ± 7.3 years (range: 60-95), with 180 (85.7%) women. The templating group achieved a mean LLD of 1.8 ± 3.5 mm (range: -5.6 to 10.2 mm), significantly better than 3.5 ± 5.5 mm (range: -10.9 to 18.4 mm) in the conventional group (p = 0.023). LLD within ± 6 mm was observed in 87.1% (61 cases) of the templating group versus 59.3% (83 cases) in the conventional group (p < 0.001). FO differences averaged 0.8 ± 2.6 mm (range: -7.2 to 6.1 mm) in the templating group, compared to -0.8 ± 3.7 mm (range: -9.8 to 5.7 mm) in the conventional group (p = 0.005). FO differences within ± 5 mm occurred in 92.9% (65 cases) of the templating group versus 82.1% (115 cases) in the conventional group (p = 0.038).
The smartphone-based digital templating method using presentation software enhances the accuracy of leg length and FO equalization during BHA for elderly FNF patients, offering significant advantages over conventional techniques.
III.
恢复股骨偏心距（FO）和均衡双下肢长度对于老年患者股骨颈骨折（FNF）行双极半髋关节置换术（BHA）获得最佳疗效及预防双下肢长度差异（LLD）至关重要。然而，关于数字模板技术优势的证据仍然有限。本研究评估了一种基于智能手机的数字模板技术在BHA中均衡双下肢长度和FO的准确性，并与传统术中方法进行比较。
对2018年6月至2023年5月期间接受BHA的210例年龄≥60岁的FNF患者进行回顾性队列研究。模板组（n = 70）在iPhone上使用Keynote演示软件进行术前数字模板设计，并纳入股骨假体模板。传统组（n = 140）依靠术中视觉估计、触诊和摇晃试验。术后通过X线评估LLD和FO差异。
患者平均年龄为74.9±7.3岁（范围：60 - 95岁），其中180例（85.7%）为女性。模板组的平均LLD为1.8±3.5 mm（范围：-5.6至10.2 mm），显著优于传统组的3.5±5.5 mm（范围：-10.9至18.4 mm）（p = 0.023）。模板组87.1%（61例）的患者LLD在±6 mm以内，而传统组为59.3%（83例）（p < 0.001）。模板组的FO差异平均为0.8±2.6 mm（范围：-7.2至6.1 mm），传统组为-0.8±3.7 mm（范围：-9.8至5.7 mm）（p = 0.005）。模板组92.9%（65例）的患者FO差异在±5 mm以内，传统组为82.1%（115例）（p = 0.038）。
使用演示软件的基于智能手机的数字模板技术提高了老年FNF患者BHA期间双下肢长度和FO均衡的准确性，与传统技术相比具有显著优势。
III级
