人工股骨头置换术与人工全髋置换术治疗老年股骨颈骨折的临床疗效比较
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摘要
目的:通过人工股骨头置换术组与人工全髋置换术组治疗老年股骨颈骨折的临床疗效对比,对人工股骨头置换术与人工全髋置换术的治疗效果进行分析。
方法:通过回顾研究广西医科大学第三附属医院骨科从2003年3月至2009年3月期间收治的57例老年股骨颈骨折患者,将患者分为两组。A组为人工股骨头置换组,B组为人工全髋置换术组。通过两组患者的手术时间、术中失血量、术后引流量、住院时间、术后负重时间、术后早期并发症、术后远期并发症及术后髋关节功能恢复程度等方面来比较它们的差异。
结果:两组病人经过6个月～6年(平均26.5月)随访,人工股骨头置换组和全髋关节置换组在住院时间、术后负重时间,术后早期并发症方面比较,差异无统计学意义(p>0.05);而在手术时间、术中出血量、术后引流量、术后远期并发症及髋关节功能方面比较,差异有统计学意义(p <0.05)。
结论:老年股骨颈骨折行人工全髋关节置换后关节功能恢复较好,远期并发症较低,是人工髋关节置换治疗的首选方法。即使是高龄患者,如自身身体状况许可,预期寿命长或活动量较大者,亦优先选择人工全髋置换术。人工股骨头置换术适用于身体情况较差、预期寿命短或活动量小的患者。
Objective:By comparing the clinical therapeutics of artificial femoral head replacement group with total hip arthroplasty group of therapy of the elderly femoral neck fracture, to analyze the treatment effect of the two surgical procedures.
Method:Based on the observation of 57 cases of patients with elderly femoral neck fracture in the Third Affiliated Hospital of Guangxi Medical University from March 2003 to March 2009, we separated the patients into two groups, group A for artificial femoral head replacement and B for total hip arthroplasty. We compared the two groups from operative time, intra-operative blood lose, postoperative drainage, hospitalization period, time of postoperative weight-bearing, early postoperative complications, long-term postoperative complications, and postoperative recovery of hip function.
Results: Two groups of patients are interviewed randomly from 6 months to 6 years, 26.5 months on average. There was no significant difference between A group with B group in hospitalization period, time of postoperative weight-bearing, and early postoperative complications (p > 0.05). However, operative time, intra-operative blood loses, postoperative drainage, long-term postoperative complications, and postoperative recovery of hip function between the two group showed significant difference (p < 0.05).
Conclusion: Total hip arthroplasty has higher recovery rate of hip function, less long-term postoperative complications, and is the preferred method of artificial hip replacement, even for elderly patients if in better health conditions, have longer life expectancy, or with larger exercise-load. Accordingly, for patients in worse health condition, with shorter life expectancy, or with smaller exercise-load, artificial femoral head replacement is a more suitable method.
方法:通过回顾研究广西医科大学第三附属医院骨科从2003年3月至2009年3月期间收治的57例老年股骨颈骨折患者,将患者分为两组。A组为人工股骨头置换组,B组为人工全髋置换术组。通过两组患者的手术时间、术中失血量、术后引流量、住院时间、术后负重时间、术后早期并发症、术后远期并发症及术后髋关节功能恢复程度等方面来比较它们的差异。
结果:两组病人经过6个月～6年(平均26.5月)随访,人工股骨头置换组和全髋关节置换组在住院时间、术后负重时间,术后早期并发症方面比较,差异无统计学意义(p>0.05);而在手术时间、术中出血量、术后引流量、术后远期并发症及髋关节功能方面比较,差异有统计学意义(p <0.05)。
结论:老年股骨颈骨折行人工全髋关节置换后关节功能恢复较好,远期并发症较低,是人工髋关节置换治疗的首选方法。即使是高龄患者,如自身身体状况许可,预期寿命长或活动量较大者,亦优先选择人工全髋置换术。人工股骨头置换术适用于身体情况较差、预期寿命短或活动量小的患者。
Objective:By comparing the clinical therapeutics of artificial femoral head replacement group with total hip arthroplasty group of therapy of the elderly femoral neck fracture, to analyze the treatment effect of the two surgical procedures.
Method:Based on the observation of 57 cases of patients with elderly femoral neck fracture in the Third Affiliated Hospital of Guangxi Medical University from March 2003 to March 2009, we separated the patients into two groups, group A for artificial femoral head replacement and B for total hip arthroplasty. We compared the two groups from operative time, intra-operative blood lose, postoperative drainage, hospitalization period, time of postoperative weight-bearing, early postoperative complications, long-term postoperative complications, and postoperative recovery of hip function.
Results: Two groups of patients are interviewed randomly from 6 months to 6 years, 26.5 months on average. There was no significant difference between A group with B group in hospitalization period, time of postoperative weight-bearing, and early postoperative complications (p > 0.05). However, operative time, intra-operative blood loses, postoperative drainage, long-term postoperative complications, and postoperative recovery of hip function between the two group showed significant difference (p < 0.05).
Conclusion: Total hip arthroplasty has higher recovery rate of hip function, less long-term postoperative complications, and is the preferred method of artificial hip replacement, even for elderly patients if in better health conditions, have longer life expectancy, or with larger exercise-load. Accordingly, for patients in worse health condition, with shorter life expectancy, or with smaller exercise-load, artificial femoral head replacement is a more suitable method.
引文
[1] Parker MJ,Khan RJ,Grawford J,et al.Hemiarthroplasty versue internal fixation for displaced intra capsular hip fractures in the elderly.Arandomised trial of 455 patients.J Bone Joint Surg(Br).2002;84(8):1150-1155.
[2]卫小春.髋关节置换-老年股骨颈骨折的有效治疗方法[J].中华医学杂志,2005,85(46):3243-3244.
[3] Mckinley JC,Robinson CM.Treatment of displaced intracapsular hip fractures with total hip arthroplasty:comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation〔J〕.J Bone Joint Surg (Am),2002,84:2010-2015.
[4] Bhandari M,Devereaux PJ,Swiontkowski MF,et al.Internal fixation compared with arthroplasty for displaced fractures of thefemoral neck.A meta analysis.J Bone Joint Surg(Am),2003,85:1673-1681.
[5] Tidermark J,Ponzer S,Svensson O,et al.Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly.A randomized,controlled trial.J Bone Joint Surg Br2003,85(3):380-388.
[6] Blomfeldt R,T?rnkvist H,et al.Comparison of internalfixation with total hip replacement for displaced femoral neck fractures. Randomized,controlled trial performed at four years.J Bone Joint Surg Am 2005,87(8):1680-1688.
[7] Keating JF,Grant A,Masson M,et al.Randomized comparison of reduction and fixation,bipolar hemiarthroplasty,and total hip arthroplasty: treatment of displaced intracapsular hip fractu- res in healthy older patients[J].J Bone JointSurg (Am),2006, 88(2):249-260.
[8]吕丹,孙明林.人工髋关节置换后假体无菌性松动的因素及其防治.中国组织工程研究与临床康复,2009,13(13):2553-2556.
[9] Phillips CB,Barrett JA,Losina E,et al.Incidence rates of Dislocation,pulmonary embolism and deep infection during the first six months after elective total hip replacement[J].J Bone Joint Surg (Am),2003,85(1):20.
[10]李佛保,盛璞义,韩士英,等。人工股骨头置换与全髋置换术治疗股骨颈骨折[J].中华骨科杂志,1999,19(3):152
[11]K Casey chan,Gurdes Gill.Cemented hemiarthroplasties for eldrly patients with intertronteric fracturesJ.Clin Ortho, 2000,317(2):206～215.
[12]Haidukewych GJ,Israel TA,Berry DJ.Long-term survivorship of cemented bipolar hemiarthroplasty for fracture of the femoral neck.Clin Orthop,2002,403:118-126.
[13]吴立东,严世贵,向荣新等.全髋与半髋关节置换术治疗老年人股骨颈骨折结果比较[J].中华创伤骨科杂志,2004,6(1):55-58.
[14]Leighton RK,Schmidt AH,Collier P,et al.Advances in the treatmentof intracapsular hip fractures in the elders.Injury,2007, 38(Supp l3):S24 - 34.
[15]肖孟堂,周敏,宋晓宾等.人工股骨头置换术与人工全髋置换术治疗股骨颈骨折的疗效观察及比较.中国现代医学杂志,2009,19(2):300-304
[16]吴梅祥,白波等.高龄老年人股骨颈骨折人工全髋与半髋关节置换术的选择.中华关节外科杂志,2009,3(3):315-319.
[17] Dalldorf PG,Banas MP,Hicks DG,et al.Rate of degeneration of human acetabular cartilage after hemiarthroplasty.J Bone Joint Surg(Am),1995,77:887-882.
[18]Ravikumar KJ,Marsh G.Internal fixation versus hemiarthro- plasty versus total hip arthroplasty for displaced subcapital fractures of femur--13 year results of a prospective randomised study.Injury 2000;31(10):793-797.
[19]张德宝,王铁军,谷贵山等.高龄股骨颈骨折患者行全髋关节置换与人工双极股骨头置换的比较.中国组织工程研究与临床康复,2008,12(9) 1651-1654.
[1]杨述华,刘勇.人工关节置换术未来发展与挑战.国外医学,2005,26 (1):3-4.
[2] Hellman EJ,Capello WN,Feinberg JR Om Hellman EJ; Capello WN; Feinberg JR Omnifit cementless total hip arthroplasty. A 10-year average follow up.Clinical orthopaedics and related research, 1999;(364):164-174.
[3]毛宾尧,人工髋关节技术进展[J].中国矫形外科杂志, 2008,16(2):115 -116.
[4]马建兵,刘淼.聚乙烯微粒细胞因子与人工髋关节松动的相关性研究.中国矫形外科杂志,2009,17(9):644-646.
[5] Weber BG.Experience with the Metasul total hip bearing system [J].Clin Orthop Relat Res,1996,(329 Supp l):69-77.
[6] Wentworth SJ,MasriBA,Duncan CP,et al.Hip prosthesis of anti- biotic-loaded acrylic cement for the treatment of infections following total hip arthroplasty[J].J Bone joint Surg Am, 2002,84:123-128.
[7] Antonucci R,Fanos V.Acute encephalopathy associated with respiratory syncytial virus infections in children.A literature review[J].Minerva Pediatr,2005,57(3):137-142.
[8] Sweetman LL,Ng YT,Butler IJ,et al.Neurologic complications associated with respiratory syncytial virus[J].Pediatric Neurology,2005,32(5):307-310.
[9]金志刚,毕云龙等.陶瓷一陶瓷髓关节置换在美国应用的经验.国际骨科学杂志,2009,30(2):81-83.
[10]Lusty PJ,Tai CC,Sew-Hoy RP,Walter WL, et al.A Third-generation alumina-on-alumina ceramic bearings in cementless total hip arthro plasty.The Journal of bone and joint surgery.American volume 2007;89(12):2676-2683.
[11]D.Granchi,G.Ciapetti,etal.The influence of alumina and ultra- high molecular weight polyethylene particles on osteoblast- osteoclast cooperation.Biomaterials,2004,25:4037-4045
[12]Garino J,RahamanMN,Bal BS.The reliability of modernal umina- bearings In total hip arthroplasty. Semin Arthro 2006,17:113- 119.
[13]Nakamura S,Matsuda K,Arai N,et al.Mini-incision posterior approach for total hip arthroplasty[J].Int Orthop,2004,28: 214-217.
[14]Dorr LD. Comparison of primary total hip replacements performed with a standard incision or a mini- incision[J].J Bone Joint Surg (Am),2005,87:675-676.
[15]Chimento GF,Pavone V,Sharrock N, et al.Minimally invasive total hip arthroplasty: a prospective randomized study[J].J Arthroplasty,2005,20:139-144.
[16]Berry DJ,Berger RA,et al.Minimally invasive total hip art- hroplasty.J Bone Joint Surg (Am),2003,85:2235-2246.
[17]郑东,杨述华等.微创全髋关节置换术研究进展.国外医学.2005,26 (1):7-9.
[18]Berger R.Paper presented at 70th Annual Meeting of the American Academy of Orthopaedic Surgeon,2003.
[19]Kennon RE,Keggi JM,Wetmore RS,et al.Total hip arthroplasty through a minimally invasive anterior surgical approach [J].J Bone Joint Surg Am 2003;85(4):39-48.
[20]Keggi,Kristaps,Keggi,et al.Minimal incision total hip arthroplasty via the anterior app roach [J].Curt Op in Orthop, 2005,16(1):10-13.
[21]Bostrom,Mathias P,Demetrakopoulos,et al.Minimally invasive posterior approach to total hip rep lacement[J].Curt Op in Orthop,2005,16(1):2-4.
[22]Barrett AR,Davies BL,Gomes MP,et al.Computer-assisted hip resurfacing surgery using the acrobot navigation system.Proc Inst Mech Eng [H].2007:221(7):773-785.
[23]Jolles BM,Genoud P,Hoffmeyer P.Computer-assisted cup place- ment techniques in total hip arthroplasty improve accuracy ofplacement[J].Clin Orthop Relat Res,2004(426):174-179.
[24]Haaker R,Tiedjen K,Rubenthaler F,et al.Computer assisted navigated cup placement in primary and secondary dysplastic hips[J].Z Orthop Ihre Grenzgeb,003,141(1):105-111.
[2]卫小春.髋关节置换-老年股骨颈骨折的有效治疗方法[J].中华医学杂志,2005,85(46):3243-3244.
[3] Mckinley JC,Robinson CM.Treatment of displaced intracapsular hip fractures with total hip arthroplasty:comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation〔J〕.J Bone Joint Surg (Am),2002,84:2010-2015.
[4] Bhandari M,Devereaux PJ,Swiontkowski MF,et al.Internal fixation compared with arthroplasty for displaced fractures of thefemoral neck.A meta analysis.J Bone Joint Surg(Am),2003,85:1673-1681.
[5] Tidermark J,Ponzer S,Svensson O,et al.Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly.A randomized,controlled trial.J Bone Joint Surg Br2003,85(3):380-388.
[6] Blomfeldt R,T?rnkvist H,et al.Comparison of internalfixation with total hip replacement for displaced femoral neck fractures. Randomized,controlled trial performed at four years.J Bone Joint Surg Am 2005,87(8):1680-1688.
[7] Keating JF,Grant A,Masson M,et al.Randomized comparison of reduction and fixation,bipolar hemiarthroplasty,and total hip arthroplasty: treatment of displaced intracapsular hip fractu- res in healthy older patients[J].J Bone JointSurg (Am),2006, 88(2):249-260.
[8]吕丹,孙明林.人工髋关节置换后假体无菌性松动的因素及其防治.中国组织工程研究与临床康复,2009,13(13):2553-2556.
[9] Phillips CB,Barrett JA,Losina E,et al.Incidence rates of Dislocation,pulmonary embolism and deep infection during the first six months after elective total hip replacement[J].J Bone Joint Surg (Am),2003,85(1):20.
[10]李佛保,盛璞义,韩士英,等。人工股骨头置换与全髋置换术治疗股骨颈骨折[J].中华骨科杂志,1999,19(3):152
[11]K Casey chan,Gurdes Gill.Cemented hemiarthroplasties for eldrly patients with intertronteric fracturesJ.Clin Ortho, 2000,317(2):206～215.
[12]Haidukewych GJ,Israel TA,Berry DJ.Long-term survivorship of cemented bipolar hemiarthroplasty for fracture of the femoral neck.Clin Orthop,2002,403:118-126.
[13]吴立东,严世贵,向荣新等.全髋与半髋关节置换术治疗老年人股骨颈骨折结果比较[J].中华创伤骨科杂志,2004,6(1):55-58.
[14]Leighton RK,Schmidt AH,Collier P,et al.Advances in the treatmentof intracapsular hip fractures in the elders.Injury,2007, 38(Supp l3):S24 - 34.
[15]肖孟堂,周敏,宋晓宾等.人工股骨头置换术与人工全髋置换术治疗股骨颈骨折的疗效观察及比较.中国现代医学杂志,2009,19(2):300-304
[16]吴梅祥,白波等.高龄老年人股骨颈骨折人工全髋与半髋关节置换术的选择.中华关节外科杂志,2009,3(3):315-319.
[17] Dalldorf PG,Banas MP,Hicks DG,et al.Rate of degeneration of human acetabular cartilage after hemiarthroplasty.J Bone Joint Surg(Am),1995,77:887-882.
[18]Ravikumar KJ,Marsh G.Internal fixation versus hemiarthro- plasty versus total hip arthroplasty for displaced subcapital fractures of femur--13 year results of a prospective randomised study.Injury 2000;31(10):793-797.
[19]张德宝,王铁军,谷贵山等.高龄股骨颈骨折患者行全髋关节置换与人工双极股骨头置换的比较.中国组织工程研究与临床康复,2008,12(9) 1651-1654.
[1]杨述华,刘勇.人工关节置换术未来发展与挑战.国外医学,2005,26 (1):3-4.
[2] Hellman EJ,Capello WN,Feinberg JR Om Hellman EJ; Capello WN; Feinberg JR Omnifit cementless total hip arthroplasty. A 10-year average follow up.Clinical orthopaedics and related research, 1999;(364):164-174.
[3]毛宾尧,人工髋关节技术进展[J].中国矫形外科杂志, 2008,16(2):115 -116.
[4]马建兵,刘淼.聚乙烯微粒细胞因子与人工髋关节松动的相关性研究.中国矫形外科杂志,2009,17(9):644-646.
[5] Weber BG.Experience with the Metasul total hip bearing system [J].Clin Orthop Relat Res,1996,(329 Supp l):69-77.
[6] Wentworth SJ,MasriBA,Duncan CP,et al.Hip prosthesis of anti- biotic-loaded acrylic cement for the treatment of infections following total hip arthroplasty[J].J Bone joint Surg Am, 2002,84:123-128.
[7] Antonucci R,Fanos V.Acute encephalopathy associated with respiratory syncytial virus infections in children.A literature review[J].Minerva Pediatr,2005,57(3):137-142.
[8] Sweetman LL,Ng YT,Butler IJ,et al.Neurologic complications associated with respiratory syncytial virus[J].Pediatric Neurology,2005,32(5):307-310.
[9]金志刚,毕云龙等.陶瓷一陶瓷髓关节置换在美国应用的经验.国际骨科学杂志,2009,30(2):81-83.
[10]Lusty PJ,Tai CC,Sew-Hoy RP,Walter WL, et al.A Third-generation alumina-on-alumina ceramic bearings in cementless total hip arthro plasty.The Journal of bone and joint surgery.American volume 2007;89(12):2676-2683.
[11]D.Granchi,G.Ciapetti,etal.The influence of alumina and ultra- high molecular weight polyethylene particles on osteoblast- osteoclast cooperation.Biomaterials,2004,25:4037-4045
[12]Garino J,RahamanMN,Bal BS.The reliability of modernal umina- bearings In total hip arthroplasty. Semin Arthro 2006,17:113- 119.
[13]Nakamura S,Matsuda K,Arai N,et al.Mini-incision posterior approach for total hip arthroplasty[J].Int Orthop,2004,28: 214-217.
[14]Dorr LD. Comparison of primary total hip replacements performed with a standard incision or a mini- incision[J].J Bone Joint Surg (Am),2005,87:675-676.
[15]Chimento GF,Pavone V,Sharrock N, et al.Minimally invasive total hip arthroplasty: a prospective randomized study[J].J Arthroplasty,2005,20:139-144.
[16]Berry DJ,Berger RA,et al.Minimally invasive total hip art- hroplasty.J Bone Joint Surg (Am),2003,85:2235-2246.
[17]郑东,杨述华等.微创全髋关节置换术研究进展.国外医学.2005,26 (1):7-9.
[18]Berger R.Paper presented at 70th Annual Meeting of the American Academy of Orthopaedic Surgeon,2003.
[19]Kennon RE,Keggi JM,Wetmore RS,et al.Total hip arthroplasty through a minimally invasive anterior surgical approach [J].J Bone Joint Surg Am 2003;85(4):39-48.
[20]Keggi,Kristaps,Keggi,et al.Minimal incision total hip arthroplasty via the anterior app roach [J].Curt Op in Orthop, 2005,16(1):10-13.
[21]Bostrom,Mathias P,Demetrakopoulos,et al.Minimally invasive posterior approach to total hip rep lacement[J].Curt Op in Orthop,2005,16(1):2-4.
[22]Barrett AR,Davies BL,Gomes MP,et al.Computer-assisted hip resurfacing surgery using the acrobot navigation system.Proc Inst Mech Eng [H].2007:221(7):773-785.
[23]Jolles BM,Genoud P,Hoffmeyer P.Computer-assisted cup place- ment techniques in total hip arthroplasty improve accuracy ofplacement[J].Clin Orthop Relat Res,2004(426):174-179.
[24]Haaker R,Tiedjen K,Rubenthaler F,et al.Computer assisted navigated cup placement in primary and secondary dysplastic hips[J].Z Orthop Ihre Grenzgeb,003,141(1):105-111.