老年髋关节置换手术中的有骨水泥和无骨水泥直茎假体对比分析:中期随访研究

M. Sapienza, Danilo Di Via, Marco Simone Vaccalluzzo, L. Costarella, V. Pavone, G. Testa
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引用次数: 0

摘要

这项回顾性队列研究评估了股骨颈骨折老年患者髋关节置换手术中直茎无骨水泥假体与骨水泥假体的有效性。我们分析了在 2018 年至 2021 年期间接受手术的 80 名 70 岁及以上的患者。临床结果采用哈里斯髋关节评分、WOMAC评分和视觉模拟量表进行评估,同时通过布罗克分类法进行放射学评估。术前 Dorr 分级和术后五项标准(下沉、皮质肥厚、基底征、放射线和应力屏蔽)用于评估植入物的疗效。结果显示,两组的中期疗效均令人满意,无骨水泥柄组的临床评分略高。有骨水泥组的 Harris 髋关节评分(HHS)平均为 74.4 ± 6.7,无骨水泥组为 79.2 ± 10.4,差异有统计学意义(p = 0.0146)。WOMAC评分显示,有骨水泥组平均为(30.1 ± 4.6)分,无骨水泥组为(27.1 ± 6.9)分,同样显示出统计学上的显著改善(p = 0.0231)。不过,放射学结果要求对长期稳定性进行重新评估。我们的统计分析包括功率计算和多变量分析,以调整混杂变量,从而对植入物的有效性进行全面评估。我们的研究结果有助于解决目前关于有骨水泥假体和无骨水泥假体之间选择的争论,表明这两种假体都是满足不同患者需求的可行选择。为了更深入地了解老年人髋关节置换手术的最佳治疗策略,进一步研究克服本研究的局限性至关重要。
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Comparative Analysis of Cemented and Cementless Straight-Stem Prostheses in Hip Replacement Surgery for Elderly Patients: A Mid-Term Follow-up Study
This retrospective cohort study assesses the effectiveness of straight-stem cementless versus cemented prostheses in hip replacement surgeries for elderly patients with femoral neck fractures. We analyzed 80 patients aged 70 and over who underwent surgery between 2018 and 2021. Clinical outcomes were evaluated using the Harris Hip Score, WOMAC Score, and Visual Analogue Scale, alongside radiological assessments through Brooker’s classification. Preoperative Dorr classification and five postoperative criteria (subsidence, cortical hypertrophy, pedestal sign, radiolucent lines, and stress shielding) were used to assess implant efficacy. The results demonstrated satisfactory mid-term outcomes for both groups, with slightly higher clinical scores observed in the cementless stem group. The Harris Hip Score (HHS) averaged 74.4 ± 6.7 in the cemented group and 79.2 ± 10.4 in the cementless group, with a statistically significant difference (p = 0.0146). The WOMAC Score showed an average of 30.1 ± 4.6 in the cemented group compared to 27.1 ± 6.9 in the cementless group, also indicating a statistically significant improvement (p = 0.0231). However, radiographic findings call for a re-evaluation of long-term stability. Our statistical analysis, which included power calculation and multivariate analysis to adjust for confounding variables, offers a comprehensive assessment of implant effectiveness. The findings contribute to the ongoing debate on the choice between cemented and cementless prostheses, indicating that both are viable options catering to different patient needs. Further research overcoming this study’s limitations is crucial for a deeper understanding of optimal treatment strategies in hip replacement surgery for the elderly.
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