髋部骨折的双活动度杯：与双极髋关节置换术相比的适应症和临床效果。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2024-09-01 DOI:10.1016/j.injury.2024.111483

E. Pala, J. Canapeti, G. Trovarelli, A. Berizzi, M.C. Cerchiaro, S. Zanarella, P. Ruggieri

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引用次数: 0

摘要

简介：对于股骨颈骨折移位患者选择半髋关节置换术（HA）还是全髋关节置换术（THA）仍存在争议。目前，越来越多的患者采用双活动度杯全髋关节置换术（DMC-THA）来防止这些高危患者发生脱位。本研究旨在回顾性分析在一个中心接受治疗的股骨颈骨折患者的功能结果、并发症发生率和死亡率，并对HA和DMC-THA进行比较：2020 年至 2022 年间，共纳入 162 例患者，其中男性 39 例，女性 123 例，平均年龄 76 岁。82例植入了HA，80例植入了DMC-THA。纳入标准为：年龄小于85岁，美国麻醉医师协会（ASA）评分低于3分，至少随访6个月。总体而言，124/162 例患者（77%）在入院后 48 小时内接受了手术治疗：结果：DMC-THA组的平均年龄为74岁，HA组为78岁。DMC-THA 组的总平均手术时间明显较长（P < 0.001）。HA 组的平均血红蛋白（Hb）损失为 1.64 g/dl，DMC-THA 组为 1.72 g/dl，两组间无差异（P = 0.573）。两组患者的存活率没有差异（P = 0.7704）。HA 组术后一个月的平均 VAS 评分为 2.1，而 DMC-THA 组为 0.9。DMC-THA组的Harris髋关节评分明显更高（P = 0.035）。感染仅发生在一名 DMC-THA 患者身上，经过清创处理。2例DMC-THA患者在首次手术后1个月内发生假体周围骨折，其中1例接受了股骨柄翻修治疗，另1例接受了固定治疗：结论：对于股骨颈骨折的老年患者，DMC-THA的功能效果优于HA。DMC-THA的平均手术时间更长，但这并不影响失血量、出院时间或一年死亡率。在我们的系列研究中，两组患者均未发生脱位。

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Dual mobility cup in hip fracture: Indications and clinical results compared with bipolar hip arthroplasty

Introduction

The choice between hemiarthroplasty (HA) and total hip arthroplasty (THA) for displaced femoral neck fractures remains debated. There is increasing use in dual mobility cup total hip arthroplasty (DMC-THA) to prevent dislocations in these high-risk patients. Aim of this study is to retrospectively analyze patients treated in a single Center for femoral neck fracture comparing HA and DMC-THA in terms of: functional outcome, rate of complications and mortality.

Material and methods

Between 2020 and 2022, 162 patients were included, 39 male and 123 female, with a mean age of 76 years old. HA were implanted in 82 cases and DMC-THA in 80 cases.

Inclusion criteria were

age < 85 years old, American Society of Anesthesiologists (ASA) score below 3, minimum follow-up of 6 months. Overall, 124/162 of patients (77%) were surgically treated within 48 h from admission.

Results

The mean age for DMC-THA group was 74 years old and 78 years old for HA group. The overall mean surgical time was significantly higher in the DMC-THA group (P < 0.001). Mean hemoglobin (Hb) loss was 1.64 g/dl in the HA group and 1.72 g/dl in the DMC-THA group with no differences between the two groups (P = 0.573). There is no difference in survival of patients between the two groups (P = 0.7704).

In the HA group, the mean one-month post-operative VAS score was 2.1, while in the DMC-THA group was 0.9. The Harris hip score was significantly better in DMC-THA group (P = 0.035) Dislocation never occured in the overall series.

Infection occurred only in one patient with DMC-THA and was treated with debridement. Periprosthetic fracture occurred in 2 cases of DMC-THA both within 1 month from the first surgery; one was treated with revision femoral stem and the second one with fixation.

Conclusions

DMC-THA offer better functional results than HA in elderly patients with femur neck fractures. The mean surgical time was longer in DMC-THA but this did not influence blood loss, time of discharge or one-year mortality. In our series dislocation never occurred in both groups.

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.