生物型与骨水泥型人工髋关节置换治疗高龄转子间骨折早期疗效的比较

目的：比较远端固定生物型股骨假体与骨水泥型股骨假体行人工髋关节置换治疗高龄股骨转子间骨折的早期临床疗效。方法回顾性分析2010年8月～2012年4月在我院骨科行人工髋关节置换治疗的59例单侧股骨转子间骨折高龄患者的临床资料，实际随访54例。随机分成两组：生物固定组21例，骨水泥组33例。比较两组住院时间、手术时间、术中出血量、术后3d总失血量、术后并发症、Harris评分以及放射学效果。结果生物固定组手术时间、术中出血均明显少于骨水泥组；生物固定组术中、术后出现假体周围骨折各1例；两组住院时间、术后3d总失血量、Harris评分、术后并发症发生率相比，差异无统计学意义（ P＞0.05）。结论生物固定组可减少术中出血、缩短手术时间并减少或消除“骨水泥植入综合征”，但术后3d总失血量无明显减少，出现假体周围骨折风险增高，术前需严格把握手术适应证。

Comparative assessment of short term outcome of cementless prosthesis versus cemented femoral stem prosthesis in hip arthroplasty for elderly intertrochanteric fracture

Objective To compare the short-term clinical effect of the distal fixed prosthesis ( cementless prosthesis ) with cemented femoral stem prosthesis in hip arthroplasty for elderly intertrochanteric fracture .Methods Fifty-nine cases(54 cases followed-up) of unilateral intertrochanteric fracture in senile patients from Aug .2010 to Apr.2012 were retrospectively analyzed and randomly divided into 2 groups.In them,21 cases underwent hip ar-throplasty using the distal fixed prosthesis ( cementless group ) ,and the other 33 were treated with cemented hip ar-throplasty (cement group).The difference was compared in time of hospitalization , time of operation,blood loss, adverse effect,Harris scoring and radiological results .Results The average operation time were (42.3 ±7.2) mi-nutes in cementless group and (51.5 ±8.3) minutes in cement group,with significant difference (P<0.05).The blood loss were (149.9 ±27.7) ml in cementless group and(205.2 ±47.3)ml in cement group,with significant differ-ence(P<0.05).Two patients developed periprosthetic femoral fracture in cementless group .There was no signifi-cant statistical difference between two groups in time of hospitalization , total blood loss 3 days after the operation ,Har-ris scoring,complications and radiographic evaluations (including radiolucent line,osteolysis) (P>0.05).Conclu-sion Hip arthroplasty using cementless prosthesis for treatment of elder patients with intertrochanteric fracture can a -chieve good short-term clinical effect alike cemented prosthesis .It helps reduce operative time ,blood loss and bone cement implantation syndrome during the operation .The medium and long term effect still needs further research . And preoperative evaluation on the shape and size of medullary cavity and the severity of osteoporosis is needed .