A comparative analysis of cemented and non cemented hemiarthroplasty in the treatment of femoral neck fracture in the elderly

doi:10.3877/cma.j.issn.2096-0263.2020.05.004

Abstract

Abstract:

Objective

To compare the effect of cemented and non-cemented non-cemented artificial hip arthroplasty in elderly patients with femoral neck fracture.

Methods

A prospective collection of 112 elderly patients with femoral neck fractures admitted to Xingtang County People's Hospital from January 2014 to December 2018 were done. The patients were divided into cemented and non-cemented groups by a random number table. 56 cases in each group. Patients in the cement group were treated with cement-type artificial hemi hip replacement. There were 26 males and 30 females, aged (72±4) years. The non-cemented group was treated with non-cemented artificial hip arthroplasty. There were 31 males and 25 females, aged (73±4) years old. The perioperative indicators, surgical effects, and complication rates of the two groups of patients were compared, and the two groups were followed up for 3 years after the operation. The Harris hip function score and the incidence of adverse events during the follow-up period were evaluated and statistical analyzed.

Results

112 patients were followed up completely, and the follow-up time was (36±5) months. There was no statistically significant difference in operation time, intraoperative blood loss, drainage volume, etc. between the two groups (P>0.05), while the hospitalization time of the bone cement group was (14±3) days and the time to start weight bearing (41±9) days were both lower than the non-cemented group [(17±3)d, (46±10)d, t=4.353, 2.856, P<0.05]. The excellent and good rate of surgery in the cement group was 87.50% (49/56), which was higher than the non-cement group [71.43% (40/56), χ²=4.432, P<0.05]. The postoperative complication rate in the cement group was 7.14% (4/56), which was lower than the non-cement group [21.43% (12/56), χ²=4.667, P<0.05]. Harris scores of patients in the bone cement group were better than the cement group (76±11, 81±9, 87±8, 91±6) at 6 months (82±14), 12 months (86±8), 24 months (91±7) and 36 months (95±4) after surgery. The incidence of adverse events in the cement group was 8.93% (5/56), which was lower than that of the non-cement group [23.21% (13/56), χ²=4.236, P<0.05].

Conclusion

Compared with non-cemented artificial hip joints, cemented artificial hip joint replacements have better surgical results for elderly patients with femoral neck fractures and good postoperative joint function recovery, which is worthy of clinical recommendation.

Key words: Femoral neck fractures, Hemiarthroplasty, Cement type, Artificial hemi hip joint, Complication rate

Ligang Jiao, Lei Zhang, Weiyou Wang. A comparative analysis of cemented and non cemented hemiarthroplasty in the treatment of femoral neck fracture in the elderly[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(05): 265-270.

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References 20

1	周洋洋,倪英杰,李荥娟,等.老年股骨颈骨折治疗研究进展[J].中国修复重建外科杂志, 2019, 29(8): 1033-1040.
2	Verma N, Singh MP, Ul-Haq R, et al. Outcome of bone marrow instillation at fracture site in intracapsular fracture of femoral neck treated by head preserving surgery [J]. Chin J Traumatol, 2017, 20(4): 222-225.
3	史茂伟,柳青,王立欣,等.长期卧床高龄老人自发性股骨颈骨折2例[J].中华保健医学杂志, 2014, 16(4): 315.
4	Watts CD, Houdek MT, Sems SA, et al. Tranexamic acid safely reduced blood loss in hemi- and total hip arthroplasty for acute femoral neck fracture: a randomized clinical trial [J]. J Orthop Trauma, 2017,31(7): 345-351.
5	戴醒明,杨效宁,孙一公,等.前外侧与后外侧路小切口髋关节置换术治疗老年股骨颈骨折的疗效比较研究[J].现代生物医学进展, 2017, 17(34): 6727-6730.
6	郭琦.生物型与骨水泥型人工半髋关节假体治疗老年股骨颈骨折的疗效及预后比较[J].生物骨科材料与临床研究, 2017, 14(1): 53-55+60.
7	李涛,王英振,李玉龙,等.骨水泥与非骨水泥半髋关节置换治疗老年股骨颈骨折安全性的Meta分析[J].中华老年骨科与康复电子杂志, 2017, 3(2): 109-115.
8	Veldman HD, Heyligers IC, Grimm B, et al. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current Generation hip stems [J]. Bone Joint J, 2017, 99-B(4): 421-431.
9	李建国.生物型与骨水泥型人工半髋关节假体治疗老年股骨颈骨折的效果及并发症比较[J].中国综合临床, 2017, 33(12): 1127-1130.
10	王娅莹,年夫春,裴立家,等.股骨近端髓内钉内固定联合抗骨质疏松药物对老年股骨粗隆间骨折患者骨代谢标志物的影响[J].中华保健医学杂志, 2017, 19(6): 521-523.
11	Filipov O, Stoffel K, Boyko G, et al. Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients [J]. Arch Orthop Trauma Surg, 2017, 137(6): 779-788.
12	Sangwon H, Minyoung O, Yoon S, et al. Risk stratification for avascular necrosis of the femoral head after internal fixation of femoral neck fractures by Post-Operative bone SPECT/CT [J]. Nucl Med Mol Imaging (2010), 2017, 51(1): 49-57.
13	李国威,郭远清,陈涛,等.两种股骨假体半髋置换治疗股骨颈骨折的比较[J].中国组织工程研究, 2017, 21(15): 2320-2324.
14	汪松,孙倩,郑欣,等.老年移位型股骨颈骨折患者骨水泥型与生物型股骨头置换病死率与并发症的Meta分析[J].中国骨与关节杂志, 2017, 6(9): 692-698.
15	Shukla R, Singh M, Jain RK, et al. Functional outcome of bipolar prosthesis versus total hip replacement in the treatment of femoral neck fracture in elderly patients [J]. Malays Orthop J, 2017, 11(1): 1-5.
16	董文涛,彭吾训,周永芳,等.骨水泥型与生物型假体髋关节置换术治疗老年不稳定型股骨颈骨折的疗效[J].中国老年学杂志, 2017, 37(8): 1968-1969.
17	刘凯,王永才,王红川,等.骨水泥与非骨水泥半髋关节置换治疗老年股骨颈骨折术后感染相关并发症发生的Meta分析[J].华西医学, 2018, 33(9): 1118-1123.
18	菅永志,方钦正,顾培伦,等.骨水泥型与非骨水泥型半髋关节置换治疗老年移位型股骨颈骨折疗效的Meta分析[J].中国老年学杂志, 2019, 39(6): 1357-1362.
19	刘守应,蔡胥,王继芳.二期翻修治疗髋关节置换术后感染临床分析[J].中华保健医学杂志, 2015, 17(2): 126-128.
20	王永伟,徐鸿,牛连生,等.骨水泥或生物型人工股骨头置换术治疗老年股骨颈骨折中期随访结果分析[J].中国综合临床, 2018, 34(3): 258-261.

组别	例数	性别（例）		年龄（岁， ±s）	BMI（kg/m²， ±s）	骨折部位（例）		Garden分型（例）		ASA分级（例）
组别	例数	男性	女性	年龄（岁， ±s）	BMI（kg/m²， ±s）	左侧	右侧	Ⅲ型	Ⅳ型	I级	Ⅱ级
骨水泥组	56	26	30	72±4	22.4±2.9	29	27	30	26	31	25
非骨水泥组	56	31	25	73±4	22.1±2.9	24	32	27	29	35	21
t/χ²值	?	0.893		0.928	0.692	0.895		0.712		0.590
P值	?	0.345		0.355	0.512	0.344		0.398		0.442

组别	例数	性别（例）		年龄（岁， ±s）	BMI（kg/m²， ±s）	骨折部位（例）		Garden分型（例）		ASA分级（例）
组别	例数	男性	女性	年龄（岁， ±s）	BMI（kg/m²， ±s）	左侧	右侧	Ⅲ型	Ⅳ型	I级	Ⅱ级
骨水泥组	56	26	30	72±4	22.4±2.9	29	27	30	26	31	25
非骨水泥组	56	31	25	73±4	22.1±2.9	24	32	27	29	35	21
t/χ²值	?	0.893		0.928	0.692	0.895		0.712		0.590
P值	?	0.345		0.355	0.512	0.344		0.398		0.442

组别	例数	手术时间（min）	术中失血量（ml）	引流量（ml）	住院时间（d）	开始负重时间（d）
骨水泥组	56	121±19	298±46	56±9	14±3	41±9
非骨水泥组	56	118±18	287±44	54±10	17±3	46±10
t值	?	0.922	1.302	0.998	4.353	2.856
P值	?	0.359	0.196	0.320	0.000	0.005

组别	例数	手术时间（min）	术中失血量（ml）	引流量（ml）	住院时间（d）	开始负重时间（d）
骨水泥组	56	121±19	298±46	56±9	14±3	41±9
非骨水泥组	56	118±18	287±44	54±10	17±3	46±10
t值	?	0.922	1.302	0.998	4.353	2.856
P值	?	0.359	0.196	0.320	0.000	0.005

组别	例数	优	良	一般	差	优良率
骨水泥组	56	20（35.71）	29（51.79）	4（7.14）	3（5.36）	49（87.50）
非骨水泥组	56	17（30.36）	23（41.07）	9（16.07）	7（12.50）	40（71.43）
χ²值	?	?	?	4.432	?	?
P值	?	?	?	0.035	?	?

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