背景:研究认为单纯股骨头疾病而髋臼侧尚可的患者适合半髋置换,关于采用骨水泥型和非骨水泥型(即生物型)固定方式的适应证选择及近期和远期固定效果、并发症等差异的报道出入较大.目的:对比分析两种股骨假体半髋置换修复股骨颈骨折的效果及CT三维重建在移位性骨折中的应用.方法:回顾性分析73例股骨颈骨折全部行人工股骨头置换患者资料,分骨水泥假体组和非骨水泥假体组.并随访1.5年,比较各项手术指标、住院时间、髋关节功能,通过同时检查髋关节X射线片及三维CT,比较与术中所见的符合程度.结果与结论:①两组患者有效率差异无显著性意义(P>0.05);②非骨水泥组手术时间少于骨水泥组(P<0.05);置换中出血量骨、住院天数水泥组少于非骨水泥组且有统计学差异(P<0.05);③置换后1个月骨水泥组关节Harris评分高于非骨水泥组(P<0.05);置换后18个月非骨水泥组关节Harris评分高于骨水泥组(P<0.05);置换后3,6,12个月两组评分无明显差异;④2组患者三维重建和术中所见无误差,符合率达100%;⑤结果提示,应综合考虑股骨颈骨折患者年龄、基础疾病、骨条件选择相应类型半髋置换,对于高龄且严重骨质疏松严重能接受手术的患者,建议选择骨水泥型假体;对骨量条件良好者优先考虑非骨水泥型;CT三维重建对移位型骨折诊断准确率及全面认识优于X射线片.%BACKGROUND: Studies have shown that hemiarthroplasty is suitable for single femoral head diseases with normal acetabulum. But indications for choosing bone cement or biological fixation types, short- and long-term efficacy as well as the complications have not yet reached agreement.OBJECTIVE: To discuss the efficacy of two kinds of femoral prosthesis for femoral neck fractures in hemiarthroplasty,and the application of three-dimensional CT reconstruction in displaced fractures.METHODS: Clinical data of 73 cases of femoral head fractures undergoing hemiarthroplasty were analyzed retrospectively, and divided into bone cement and biological groups. All patients were followed up for 1.5 years, and the operation indexes, hospitalization time and hip joint function were compared; the consistent degree with intraoperative findings was compared through hip three-dimensional CT and X-ray examination simultaneously.RESULTS AND CONCLUSION: (1) There was no significant difference in the effective rate between groups (P > 0.05).(2) The operation time in the biological group was significantly shorter than that in the bone cement group (P < 0.05); the intraoperative blood loss and hospitalization time in the bone cement group were significantly less than those in the biological group (P < 0.05). (3) The Harris scores in the bone cement group were significantly higher than those in the biological group at 1 month after replacement (P < 0.05); the Harris scores in the biological group were significantly higher than those in the bone cement group at 18 months after replacement (P < 0.05); while there were no significant differences between two groups at 3, 6 and 12 months after replacement. (4) The hip three-dimensional reconstruction and X-ray examination showed no error compared with the intraoperative findings, reaching 100%. (5) Our findings suggest that age, disease history and bone quality should be considered when choosing an appropriate type of hemiarthroplasty for the patients with femoral neck fractures, and bone cement prosthesis is suitable for the elder patients with severe osteoporosis; while those with good bone quality should receive biological prosthesis. Besides, the diagnosis accuracy of three-dimensional reconstruction is superior to X-ray examination, which is conductive to fully understand displaced fractures.
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