Wathne R A, Koval K J, Aharonoff G B, Zuckerman J D, Jones D A
Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, New York 10003, USA.
J Orthop Trauma. 1995;9(4):298-302. doi: 10.1097/00005131-199509040-00005.
Between January 1, 1987, and December 31, 1992, 140 community-dwelling geriatric patients > or = 65 years of age with a displaced femoral neck fracture (Garden III-IV) underwent primary prosthetic replacement and were followed prospectively for a minimum of 1 year. Overall, 92 patients received a cemented bipolar prosthesis and 48 patients received a cemented modular unipolar prosthesis. There were no statistically significant differences between the two groups with respect to preinjury characteristics (age, sex, and number and severity of medical comorbidities) and functional ability. There were no statistically significant differences between the two groups with regard to the number of postoperative complications, length of stay, and 1 year mortality rate. An in-depth functional evaluation was obtained as follows: level of ambulation, independence in basic activities of daily living (feeding, bathing, dressing, toileting), and independence in instrumental activities of daily living (food shopping, food preparation, banking, laundry, housework, and use of public transportation). At 1 year follow-up, no statistically significant differences in functional ability were identified between the unipolar and bipolar groups. Furthermore, at a minimum of 1 year follow-up, there were no statistically significant differences between the two groups with regard to the need for revision surgery or the incidence hip pain. Based on the results of this study, there does not appear to be any advantage to the use of bipolar endoprosthesis for the treatment of femoral neck fractures in the elderly patient. The lower cost of modular unipolar prostheses compared with bipolar prostheses provides additional support for their use.
在1987年1月1日至1992年12月31日期间，140例年龄≥65岁、股骨颈骨折移位（Garden III-IV型）的社区老年患者接受了初次假体置换，并进行了至少1年的前瞻性随访。总体而言，92例患者接受了骨水泥型双极假体，48例患者接受了骨水泥型组合式单极假体。两组在受伤前特征（年龄、性别、内科合并症的数量和严重程度）和功能能力方面无统计学显著差异。两组在术后并发症数量、住院时间和1年死亡率方面也无统计学显著差异。进行了如下深入的功能评估：行走水平、基本日常生活活动（进食、洗澡、穿衣、如厕）的独立性以及工具性日常生活活动（食品购物、食物准备、银行业务、洗衣、家务和使用公共交通工具）的独立性。在1年随访时，单极组和双极组之间在功能能力方面未发现统计学显著差异。此外，在至少1年的随访中，两组在翻修手术需求或髋部疼痛发生率方面也无统计学显著差异。基于本研究结果，对于老年患者股骨颈骨折的治疗，使用双极假体似乎没有任何优势。与双极假体相比，组合式单极假体成本较低，这为其使用提供了额外支持。
