Total hip arthroplasty versus bipolar hemi-arthroplasty for the treatment of elderly osteoporotic femoral neck fracture

doi:10.3969/j.issn.2095-4344.2013.22.004

Abstract

Abstract:

BACKGROUND: Total hip arthroplasty and bipolar hemi-arthroplasty are effective methods for the treatment of elderly osteoporotic femoral neck fracture. Due to the influence of physical condition and the underlying disease, the choice of the way for joint replacement in clinic should be considered carefully.
OBJECTIVE: To compare the short-term outcomes of total hip arthroplasty and bipolar hemi-arthroplasty for the treatment of elderly osteoporotic femoral neck fracture.
METHODS: Seventy-five patients with osteoporotic femoral neck fracture were treated by artificial joint replacement, including 38 cases in total hip arthroplasty group and 37 cases in the bipolar hemi-arthroplasty group. The average age was (68.4±5.3) years in the total hip arthroplasty group and (72.5±6.2) years in the bipolar hemi-arthroplasty group. The Harris’ hip scores, Merled-Aubigne-Postel hip function grades, operative blood loss, replacement time, postoperative complications and mortality were analyzed and compared in these two groups.
RESULTS AND CONCLUSION: All the 75 patients were followed-up for more than 8 months. There were no significant differences in the postoperative hip pain, hip joint range of motion and hip walking ability scores between two groups (P > 0.05). There were no significant differences in postoperative complications and mortality between two groups (P > 0.05). The average operation time in the total hip arthroplasty group was longer than that in the bipolar hemi-arthroplasty group, and the operative blood loss in the total hip arthroplasty group was significantly larger than that in the bipolar hemi-arthroplasty group (P < 0.05). The bipolar hemi-arthroplasty for the treatment of elderly osteoporotic femoral neck fracture has the advantages of short operation time and little operative blood loss, and the operative outcome is as good as the total hip arthroplasty.

Key words: bone and joint implants, artificial prosthesis, femoral neck fracture, total hip arthroplasty, bipolar hemi-arthroplasty, hip joint, joint replacement, Harris score, osteoporosis, range of motion

CLC Number:

R318

Wang Lei, Liu Qing-kuan, Zhang Yuan-min, Wang Xiu-mei, Kong Ying, Duan Guo-qing. Total hip arthroplasty versus bipolar hemi-arthroplasty for the treatment of elderly osteoporotic femoral neck fracture[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(22): 4013-4017.

Figures/Tables 1

2.1 参与者数量分析纳入患者75例，分为2组，两组患者均随访超过8个月，最长46个月。全部进入结果分析。 2.2 两组患者基线资料比较两组患者在性别、年龄、身高、体质量指数方面比较，差异无显著性意义，具有可比性。见表1。 2.3 两组患者置换后疗效全髋置换组：优28例，良7例，可2例，差1例；半髋置换组：优26例，良7例，可3例，差1例，两组优良率比较差异无显著性意义(χ2= 0.188 4，P > 0.05)。Harris评分中的疼痛亚组评分，全髋置换组：无痛或可忽略25例，轻微疼痛7例，较痛4例，中度疼痛2例。半髋置换组：无痛或可忽略17例，轻微疼痛13例，较痛5例，中度疼痛2例。两组的疼痛亚组评分情况比较差异无显著性意义(χ2=0.1281，P > 0.05)。 2.4 Merled-A’ubigne-Postel髋关节功能分级在疼痛亚组分级中，全髋置换组中Ⅲ级1例，Ⅳ级2例；半髋置换组中Ⅲ级2例，Ⅳ级3例。两组的疼痛亚组分级情况比较差别无显著性意义(χ2=0.621 1，P > 0.05)。在活动范围亚组分级上，全髋置换组中6级30例，半髋置换组中6级26例。两组的活动范围亚组分级情况比较差别无显著性意义(χ2=0.746 2，P > 0.05)。行走能力亚组分级上，全髋置换组中3级2例，4级1例，半髋置换组中3级3例，4级4例，两组的行走能力亚组分级情况比较差异无显著性意义(χ2=1.971 6，P > 0.05)。说明置换后髋关节疼痛、髋关节活动范围及髋关节行走能力评分比较，全髋置换组均不高于半髋置换组(P > 0.05)。 2.5 两组患者髋关节置换时间及置换中出血量全髋置换组平均置换时间及置换中出血量分别为(70.1± 15.4) min，(550.6±122.4) mL；半髋置换组平均置换时间及置换中出血量分别为(40.2±12.36) min，(273.4± 118.5) mL。两组的平均置换时间及置换中出血量比较，差异有显著性意义(P < 0.05)。 2.6 患者术后并发症全髋置换组中发生并发症5例，并发症包括：大腿痛2例、肺部感染2例、深静脉血栓1例、贫血1例。半髋置换组4例，并发症包括：深静脉血栓2例、肺炎1例、贫血1例。术后1年有2例死亡患者，其中半髋置换组1例，死于高血性心脏病; 全髋置换组1例，死于脑血管意外。两组术后并发症及死亡率比较，差异无显著性意义(P > 0.05)。 2.7 假体植入材料与宿主不良反应局部反应：5例发生局部炎症，4例发生刺激反应，3例发生过敏反应，组织增生，2例发生材料腐蚀、磨损、生物降解、材料退化等。全身反应：5例发生炎症和过敏现象，2例发生细胞毒性，4例发生补体激活，免疫反应等。"

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