骨水泥型和非骨水泥型股骨柄假体在骨质疏松患者人工股骨头置换中的应用

摘要

背景：人工股骨头置换是一种成熟的重建髋关节的功能方法，尤其适用于不能耐受全髋关节置换的高龄患者。然而针对合并骨质疏松症患者的人工股骨头置换，使用骨水泥型还是非骨水泥型股骨柄假体在临床上尚存在较多争议。目的：观察骨质疏松症患者行人工股骨头置换时采用骨水泥型与非骨水泥型股骨柄假体的修复效果。方法：回顾性分析105例患者行人工股骨头置换的临床资料，所有患者置换前均通过双能X射线吸收测量法诊断为骨质疏松症，根据股骨柄假体类型的不同，将患者分为2组，其中骨水泥组患者56例，非骨水泥组患者49例。从手术时间、置换后引流量、置换后随访髋关节功能Harris评分及影像学评估(假体下沉、骨溶解、重度应力遮挡、异位骨化)4个方面进行对比，分析骨质疏松症患者在人工股骨头置换中采用骨水泥型和非骨水泥型假体的疗效差异。结果与结论：在骨质疏松症患者的人工股骨头置换中，骨水泥组患者手术时间明显长于非骨水泥组(P <0.05)；而两组患者的置换后引流量差异无显著性意义(P >0.05)。两组患者在置换后第1，3，6，12个月随访中的髋关节功能Harris评分、总优良率及影像学评估结果差异均无显著性意义(P >0.05)。提示在骨质疏松症患者的人工股骨头置换中，非骨水泥型股骨柄假体与骨水泥型假体临床修复效果相近，两种假体均可选用；但针对基础情况差不能耐受长时间手术的患者，非骨水泥型假体较短的手术时间可作为优先考虑的一个方面。%BACKGROUND:Hemiarthroplasty is a proven method for reconstruction of the hip joint function, especialy for the elderly patients who cannot tolerate the total hip arthroplasty. However, for the patients with osteoporosis, there are stil more controversial in clinical practice about using cemented or cementless femoral prosthesis for hemiarthroplasty. OBJECTIVE: To observe the repair effect of cemented or cementless femoral prosthesis when were used for hemiarthroplasty in patients with osteoporosis. METHODS:The clinical data from 105 patients treated with hemiarthroplasty were retrospectively analyzed. Osteoporosis was diagnosed in these patients using the dual energy X-ray absorptiometry before surgery.Patients were divided into bone cement group (n=56) and cementless group (n=49) depending on different types of femoral stem prosthesis. The difference of efficacy between cemented or cementless femoral prosthesis when were used for hemiarthroplasty in patients with osteoporosis was analyzed by comparing the operative time, volume of drainage, post-operative Harris scores of hip joint function and radiographic assessment (prosthesis subsidence, osteolysis, severe stress shielding, heterotopic ossification) during the folow-up after the replacement. RESULTS AND CONCLUSION:In the process of hemiarthroplasty in patients with osteoporosis, the operative time in the cement group was significantly longer than that in the cementless group (P < 0.05). However, there was no significant difference in the postoperative volume of drainage between these two groups (P > 0.05). At the 1, 3, 6 and 12 of folow-up after replacement, there were no significant differences in the Harris score of hip joint function, total effective rate and radiographic assessment between these two groups (P> 0.05). These results suggest that in the process of hemiarthroplasty in patients with osteoporosis, the clinical efficacy of cementless femoral prosthesis is similar to the cement femoral prosthesis, therefore two prostheses can al be selected; however, the operative time of the cement femoral prosthesis is longer than the cementless femoral prosthesis, so we can give priority to the cementless femoral prosthesis for patients with osteoporosis who can’t tolerate a long operative time because of the poor basic condition.