CAJ | 학술논문

背景：老年髋部骨折患者数目巨大，该人群多合并多种内科疾病，全身一般情况较差，与全髋关节置换相比人工双极股骨头置换可以缩短手术时间，减少麻醉时间，提高安全性，但具体使用哪种固定方式一直存在争议。 　　目的：比较老年骨质疏松性复杂髋部骨折患者应用生物型或骨水泥型股骨柄假体行人工双极股骨头置换的安全性及疗效差异。 　　方法：选择2007年6月至2010年6月因骨质疏松性髋部骨折在新疆维吾尔自治区人民医院接受人工双极股骨头置换的75岁以上老年患者198例，按选用的假体类型分为两组，生物型组69例，骨水泥型组129例，两组置换后均常规治疗骨质疏松。比较两组患者手术时间、术中出血量、置换后髋部疼痛发生率、置换后下床活动时间、末次随访的Harris评分及假体松动率的差异。 　　结果与结论：198例患者中176例获得为期48-84个月的随访，其中骨水泥组122例，生物型组54例。骨水泥组手术时间较生物型组长，但置换后下地负重时间早于生物型组，差异均有显著性意义(P <0.05)；置换后末次随访时松动及髋部疼痛的发生率骨水泥组多于生物型组，差异有显著性意义(P <0.05)；两组术中出血量、末次随访的Harris评分比较差异无显著性意义(P>0.05)。在假体松动率方面，骨水泥组的发生率为5%，生物型组的发生率为4%，差异有显著性意义(P <0.05)。提示应用生物型或骨水泥型髋关节假体行人工双极股骨头置换修复老年骨质疏松性髋部骨折均有较好的中长期疗效，骨水泥型假体可以缩短患者下地时间，但手术时间、后期髋部疼痛及假体松动发生率均高于生物型假体。
배경：노년관부골절환자수목거대，해인군다합병다충내과질병，전신일반정황교차，여전관관절치환상비인공쌍겁고골두치환가이축단수술시간，감소마취시간，제고안전성，단구체사용나충고정방식일직존재쟁의。 　　목적：비교노년골질소송성복잡관부골절환자응용생물형혹골수니형고골병가체행인공쌍겁고골두치환적안전성급료효차이。 　　방법：선택2007년6월지2010년6월인골질소송성관부골절재신강유오이자치구인민의원접수인공쌍겁고골두치환적75세이상노년환자198례，안선용적가체류형분위량조，생물형조69례，골수니형조129례，량조치환후균상규치료골질소송。비교량조환자수술시간、술중출혈량、치환후관부동통발생솔、치환후하상활동시간、말차수방적Harris평분급가체송동솔적차이。 　　결과여결론：198례환자중176례획득위기48-84개월적수방，기중골수니조122례，생물형조54례。골수니조수술시간교생물형조장，단치환후하지부중시간조우생물형조，차이균유현저성의의(P <0.05)；치환후말차수방시송동급관부동통적발생솔골수니조다우생물형조，차이유현저성의의(P <0.05)；량조술중출혈량、말차수방적Harris평분비교차이무현저성의의(P>0.05)。재가체송동솔방면，골수니조적발생솔위5%，생물형조적발생솔위4%，차이유현저성의의(P <0.05)。제시응용생물형혹골수니형관관절가체행인공쌍겁고골두치환수복노년골질소송성관부골절균유교호적중장기료효，골수니형가체가이축단환자하지시간，단수술시간、후기관부동통급가체송동발생솔균고우생물형가체。
BACKGROUND:The number of elderly patients with hip fracture is huge, and this population mainly combines with a variety of internal diseases. The general condition was bad. Compared to total hip arthroplasty, bipolar hemiarthroplasty can shorten operation time, reduce the time of anesthesia and improve surgical safety, but the operation using which fixation mode is always controversial. OBJECTIVE:To compare the safety and curative effects of bipolar hemiarthroplasty with cementless or cement femoral stem prosthesis in elderly patients with osteoporotic complex hip fracture. METHODS:From June 2007 to June 2010, 198 elderly patients with osteoporotic hip fracture aged more than 75 years old, who were treated with bipolar hemiarthroplasty in the People’s Hospital of Xinjiang Uygur Autonomous Region, China, were enroled in this study. Al patients were divided into cementless group (n=69) and cement group (n=129) according to the type of prognosis. Osteoporosis was treated conventionaly in both groups after replacement. Operation time, intraoperative blood loss, incidence of postoperative hip pain, out of bed activity time post surgery, Harris scores of last folow-up and loosening rate of the prognosis were compared between the two groups. RESULTS AND CONCLUSION:176 of above 198 cases were folowed up for 48 to 84 months, including 122 in the cement group and 54 in the cementless group. Operation time was longer in the cement group than in the cementless group, but out of bed time was earlier in the cement group than in the cementless group post surgery, and there were significant differences (P < 0.05). The incidences of loosening and hip pain were more in the cement group than in the cementless group post surgery (P < 0.05). No significant difference in intraoperative blood loss and Harris scores of last folow-up was detected between the two groups (P > 0.05). The incidences of loosening rate were 5% and 4% in the cement and cementless groups, respectively, which showed significant differences (P< 0.05). These results indicate that bipolar hemiarthroplasty with or without cement for osteoporotic hip fracture in the elderly can obtain good middle- and long-term effects. Bipolar hemiarthroplasty with cement can reduce the out of bed time, but operation time was longer, and incidences of hip pain and loosening were higher in cement prosthesis than in cementless prosthesis.