Middle- and short-term follow-up of biological artificial femoral head replacement in elderly patients with proximal femoral fracture of chronic renal disease

doi:10.3969/j.issn.2095-4344.0759

Abstract

Abstract:

BACKGROUND: Fracture of the proximal femur is common in the elderly. Biological artificial femoral head replacement is one of the main methods of surgical treatment, but in the patients with chronic renal disease, the surgical efficacy and safety are variously reported.

OBJECTIVE: To analyze the middle- and short-term effects of biological artificial femoral head replacement in elderly patients with proximal femoral fracture of chronic renal disease.

METHODS: Biological artificial femoral head replacement was used to treat 53 patients with proximal femoral fractures (aged 75 years and over). They were divided into two groups according to renal function: chronic renal disease group (n=25) and non-chronic renal disease group (n=28). Operation time, intraoperative blood loss, intraoperative blood transfusion, postoperative drainage volume of 24 hours, and partial and complete weight-bearing time, hospitalization time, hospitalization expenses and complications were compared between the two groups. Harris hip joint function score, dual energy X-ray bone density, prosthesis loosening, periprosthetic osteolysis and implant survival rate were compared in the two groups during follow-up.

RESULTS AND CONCLUSION: (1) In the non-chronic renal disease group, one patient died of respiratory failure at 1 month after replacement, and one case was refurbished at 3 months after replacement. In the chronic renal disease group, one patient died of cardiopulmonary failure at 3 months after replacement. Other patients in both groups were followed up for 1-8 years. The repair efficacy was satisfactory. (2) The excellent and good rate of hip function Harris score was 83% and 85% at 6 months after operation in chronic renal disease group and non-chronic renal disease group, respectively (P > 0.05). (3) No significant differences in operation time, blood loss, the volume of drainage 24 hours after the operation, the partial and complete weight-bearing time and dual energy X-ray bone density were determined between the two groups. The blood transfusion was larger; hospitalization time was longer; hospitalization expenses were more in the chronic renal disease group compared with the non-chronic renal disease group. (4) Patients in the two groups experienced different degrees of osteolysis, but no obvious prosthesis loosening was found. One patient in the non-chronic renal disease group underwent revision because of repeated dislocation of the prosthesis. The survival rates of the prosthesis in the chronic renal disease group and non-chronic renal disease group were 100% and 96% respectively (P > 0.05). (5) For elderly patients with proximal femoral fracture of chronic renal disease, the biological artificial femoral head replacement obtained good repair efficacy, and the function of the limbs was improved obviously with careful preoperative preparation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Femoral Fractures, Arthroplasty, Replacement, Hip Joint, Tissue Engineering

CLC Number:

R318

Zuo Wei-min, Yang Long, Wang Jian-ji, Ye Chuan. Middle- and short-term follow-up of biological artificial femoral head replacement in elderly patients with proximal femoral fracture of chronic renal disease [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(15): 2315-2320.

Figures/Tables 3

2.2 基线资料比较 2组患者共53例，其中伴有慢性肾功能不全患者25例，不伴有慢性肾功能不全患者28例，2组均为单侧初次髋关节置换，2组基线资料比较差异无显著性意义(P >0.05)，具有可比性，见表1。根据Dorr等[13]提出的方法，对患者的股骨近端髓腔进行分型。所有患者伤前均能站立行走，术前均合并有一种或多种内科疾病。所有患者根据美国麻醉医师协会(ASA)病情评估分级标准，对患者术前的健康状况进行评估，其中伴有慢性肾功能不全组Ⅱ级9例、Ⅲ级14例、Ⅳ级2例，不伴有慢性肾功能不全组Ⅱ级11例、Ⅲ级16例、Ⅳ级1例。 2.3 手术一般情况 2组患者手术均顺利完成，在手术时间、出血量、术后24 h引流量、部分及完全负重时间方面2组差异无显著性意义(P > 0.05)；慢性肾功能不全组输血量更大(图2)，住院时间更长，住院花费更大，差异有显著性意义(P < 0.01)，见表2。并发症方面，非慢性肾功能不全组泌尿系感染1例，深静脉血栓2例，心功能不全加重1例，术后急性精神障碍3例，经积极治疗后，恢复良好，1例术后并发肺部感染、慢阻肺加重，并最终于置换后1个月死于呼吸衰竭；慢性肾功能不全组泌尿系感染2例，深静脉血栓1例，心功能不全加重3例，术后急性精神障碍2例，其中1例心功能不全加重患者置换后3个月死于心肺功能衰竭，余患者经治疗后恢复良好。 2.4 随访情况 2.4.1 临床疗效评价 2组患者手术效果均满意。慢性肾功能不全组及非慢性肾功能不全组术后6个月髋关节功能Harris评分优良率分别为83%及85%，差异无显著性意义(P > 0.05)。非慢性肾功能不全组1例置换后1个月死于呼吸衰竭，1例患者因术后反复脱位最终进行了翻修。慢性肾功能不全组1例置换后3个月死于心肺功能衰竭。2组患者置换后6个月Harris评分均有不同程度提高，但差异无显著性意义(P > 0.05)，见表3。2组患者置换后6个月股骨干骺端双能X射线骨密度值均有不同程度减小，但差异无显著性意义(P > 0.05)，见表4。 2.4.2 术后影像学评价 2组患者术后X射线片检查示假体位置良好，无明显畸形，充填满意，下肢长度基本恢复，无假体周围骨折。根据Gruen等提出X射线片上股骨假体周围骨溶解7分区法，非慢性肾功能不全组末次随访时4例患者出现假体周围骨溶解，其中3例为7区的骨溶解，1例为1区的骨溶解。慢性肾功能不全组末次随访时4例出现假体周围骨溶解，2例为7区，1例为2区，1例为1区，见图3。根据Engh评定标准，股骨侧假体可分为稳定的骨长入连接，纤维连接及不稳定，2组患者末次随访时均可见稳定的骨长入，无明显假体松动、下沉等并发症。 2.4.3 假体生存率分析以任何原因进行关节翻修为研究终点，2组患者的Kaplan-Meier生存分析曲线显示，非慢性肾功能不全组假体生存率为96%，慢性肾功能不全组假体生存率为100%，生物型假体中期临床效果满意，见图4。 2.5 典型病例女性患者，90岁，慢性肾功能不全 CKD-Ⅴ期，摔伤致右股骨近端骨折，行右侧生物型人工股骨头置换术，治疗相关图片见图5。 2.6 可能影响结果的因素患者术前合并的内科疾病可能会导致术后并发症的发生，从而延长患者的住院天数，增加患者的住院费用；手术时细致的操作可以减少术中假体周围骨折的发生率；术前根据患者的股骨髓腔情况选择合适的假体以及假体的精确安装，均能减少术后假体的松动脱位等相关并发症。"

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