骨水泥型全髋关节置换术与非骨水泥型全髋关节置换术的疗效对比分析
骨水泥型和非骨水泥型髋关节应用比较
骨水泥型和非骨水泥型髋关节应用比较对于髋关节退化、创伤后或风湿性疾病髋关节磨损及髋关节骨折或缺血坏死等，现多选用股骨头置换术进行治疗，这种治疗方法可使患者尽早下床活动及康复较快及较好。
但对于选择选择骨水泥型的假体还是非骨水泥型的假体来进行治疗却争论不休。
现普遍认为使用骨水泥型的假体在置换后很少会出现肢体的疼痛，且较少发生股骨干劈裂，置换后可获得很好的髋部活动功能，并且降低了假体的翻修率。
但选择非骨水泥型的假体，其费用低，手术时间断，且不会因骨水泥而引起类似的并发症。
现分别对文献中报道的骨水泥型假体及非骨水泥型的双动头假体治疗老年性股骨颈骨折的疗效进分析，从中对比出两者在其中的疗效、使用年限的长短及舒适度，及其适合的人群。
标签：骨水泥型髋关节；非骨水泥型髋关节；髋关节置换术；应用比较在股骨颈骨折后，最常发生的并发症是股骨头的缺血坏死，但对于股骨头的缺血性坏死，目前还没确切疗效的治疗方案，特别是对于Ⅲ期以上的股骨头坏死[1-3]。
曾有文献报道，用旋转截骨、髓内减压及带血管或不带血管骨移植等方法把股骨头保留下来并让它生存下去，但以上的治疗效果均不太理想[4-5]。
对于股骨头坏死，人工全髋关节置换术是临床上选择的最终治疗方法，在掌握好了恰当的手术指征后，再选择合适的髋关节假体，加上正确的手术操作手法及术后进行有效的康复锻炼，获得了良好的疗效。
1 骨水泥型和非骨水泥型髋关节置换术骨水泥型和非骨水泥型髋关节置换术均是治疗股骨颈骨折的方法。
其中，骨水泥由粉剂和液剂（丙烯酸粘固剂、聚甲基丙烯酸甲酯）双组分构成的黏结剂或骨填充剂。
骨水泥型髋关节置换术是用骨水泥对骨折后的置换人工髋关节进行粘接固定，对骨折进行固定及作为药物控释载体等，骨水泥型假体对髋关节的固定是属于“机械固定”。
而非骨水泥中生物固定型的假体常用Zweymuller人工关节假体，它是由钛合金锻造出来的，具有良好的生物间相容性，能把髋关节假体与自身骨组织之间进行直接的固定。
髋关节人工关节假体骨水泥型与非骨水泥型的区别是怎样的？
髋关节人工关节假体骨水泥型与非骨水泥型的区别是怎样的？
在髋关节人工关节置换手术中，可以大体上分为两类：骨水泥型人工髋关节和非骨水泥型人工髋关节，由于在选择材料上的不同，价格也相差很多。
通常来说，骨水泥型适用于骨质疏松，骨质条件差，65～70岁以上的病人。
使用骨水泥人工髋关节可以早期活动，这点对老年病人也比较合适。
再有，老年病人一般活动量较少，人工关节的磨损也较轻，置换一次人工关节就可以了，一般需要翻修的较少。
骨水泥型人工关节价格偏低。
非骨水泥型又被称作生物学固定型，适用于骨质条件比较好的中青年病人，此类人工关节表面有微孔或生物涂层材料，骨质可以长入其中以达到固定人工关节的作用，所以常被称为生物固定型。
非骨水泥型人工髋关节是让自己的骨头慢慢和人工关节长在一起，来达到固定作用的。
安装这类人工关节时，要充分保证人工关节与放入的骨腔要大小匹配的非常好，不能留有空隙，同时骨腔内的骨质也要有较好的支撑和初期的固定作用，才能使人工关节稳定，便于以后骨质的长入。
而中青年人的骨质条件恰好符合这些要求，同时骨的愈合力又较强。
中青年人选用非骨水泥型人工髋关节，再做翻修的时候会容易一些。
非骨水泥型人工髋关节价格相对较高。
非骨水泥全髋关节置换：单侧与双侧效果比较
非骨水泥全髋关节置换：单侧与双侧效果比较蒋劲松;周树权;覃开兵;冯丽梅;李传杰;梁慕华;陈雪飞【摘要】背景：骨水泥对人体有一定的毒害作用，且骨水泥髋关节置换后翻修的概率较高，据报道，非骨水泥型全髋关节置换的远期固定效果明显优于骨水泥型全髋关节置换，便于翻修。
目的：探讨采用非骨水泥全髋关节置换对髋关节疾病的修复效果，并对比单侧置换与双侧置换的差异。
方法：回顾性分析广西医科大学第七附属医院梧州工人医院骨科2007年7月至2013年12月收治的233例(280髋)行非骨水泥全髋关节置换患者的临床及随访资料，根据置换方案分为单侧置换组(186例)和双侧置换组(47例)，对两组患者置换前、置换后6，12，24个月的髋关节Harris评分、大腿疼痛目测类比评分、末次随访髋关节疗效优良率及并发症等指标进行比较。
结果与结论：置换前、置换后6，12，24个月的Harris评分两组间同一时期比较差异均无显著性意义(P >0.05)，两组患者置换后6，12，24个月的Harris评分均较置换前显著升高(P <0.05)。
单侧置换组的优良率87%高于双侧组的86%，但差异并无显著性意义(P >0.05)。
置换前、置换后6，12，24个月的大腿目测类比评分两组间同一时期比较差异均无显著性意义(P>0.05)，两组患者置换后6，12，24个月的目测类比评分均较置换前显著降低(P <0.05)。
两组患者的置换后并发症发生率差异无显著性意义(P >0.05)。
提示采用非骨水泥全髋关节置换修复髋关节疾病效果显著，可有效恢复髋关节功能，单侧置换与双侧置换并无明显差异，严格置换操作，保证假体与髓腔的匹配度，可有效降低置换后大腿疼痛。
%BACKGROUND:Bone cement has certain toxic effects on the human body. The probability of renovation is high after bone cement total hip arthroplasty. It is reported that the long-term effect of cementless total hip arthroplasty is apparently better than bone cement total hiparthroplasty, and can be renovated conveniently. OBJECTIVE:To investigate the clinical effect of cementless total hip arthroplasty on hip joint disease, and to compare the difference between unilateral replacement and bilateral replacement. METHODS: Clinical and folow-up data of 233 patients (280 hips), who were treated with cementless total hip arthroplasty in the Department of Orthopedics, Wuzhou Worker’s Hospital, Seventh Affiliated Hospital of Guangxi Medical University from July 2007 to December 2013, were retrospectively analyzed. According to the replacement program, they were divided into unilateral replacement group (n=186) and bilateral replacement group (n=47). Harris score of hip joint, visual analog scale score of thigh pain, the excelent and good rate of hip joint during final folow-up and complications were compared between the two groups before replacement, at 6, 12 and 24 months after replacement. RESULTS AND CONCLUSION:No significant difference in Harris scores was detected before replacement, at 6, 12 and 24 months after replacement (P > 0.05). Harris score was significantly higher at 6, 12 and 24 months after replacement compared with that before replacement in both groups (P < 0.05). No significant difference in the excelent and good rate was detected in the unilateral replacement group (87%) and the bilateral replacement group (86%) (P > 0.05). No significant difference in the visual analog scale score was seen before replacement, at 6, 12 and 24 months after replacement (P > 0.05). Visual analog scale scores were significantly lower at 6, 12 and 24 months after replacement than that before replacement in the two groups (P < 0.05). There was no significantdifference in the incidence of complications after replacement in patients of both groups (P > 0.05). These findings confirm that the effects of cementless total hip arthroplasty for hip joint disease are evident, can effectively restore hip joint function. No significant difference was detected between unilateral replacement and bilateral replacement. Strict replacement operation and matching of prosthesis and medulary cavity can effectively reduce thigh pain after replacement.【期刊名称】《中国组织工程研究》【年(卷),期】2015(000)026【总页数】6页(P4101-4106)【关键词】植入物;人工假体;非骨水泥;全髋关节置换;髋关节疾病;单侧置换;双侧置换【作者】蒋劲松;周树权;覃开兵;冯丽梅;李传杰;梁慕华;陈雪飞【作者单位】广西医科大学第七附属医院梧州工人医院，广西壮族自治区梧州市543001;广西医科大学第七附属医院梧州工人医院，广西壮族自治区梧州市543001;广西医科大学第七附属医院梧州工人医院，广西壮族自治区梧州市543001;广西医科大学第七附属医院梧州工人医院，广西壮族自治区梧州市543001;广西医科大学第七附属医院梧州工人医院，广西壮族自治区梧州市543001;广西医科大学第七附属医院梧州工人医院，广西壮族自治区梧州市543001;广西医科大学第七附属医院梧州工人医院，广西壮族自治区梧州市543001【正文语种】中文【中图分类】R318文章亮点：1 课题采用非骨水泥人工髋关节，避免骨水泥对人体的损害，明显降低人工髋关节置换后翻修的概率；选择后外侧入路，具有小切口微创的优势；对假体设计理念的掌握及正确的操作是获得满意效果的保证。
老年股骨颈骨折应用骨水泥型单髋和全髋关节置换治疗的临床对比
老年股骨颈骨折应用骨水泥型单髋和全髋关节置换治疗的临床对比摘要：目的：对比老年股骨颈骨折应用骨水泥型单髋和全髋关节置换治疗的临床效果。
方法：将我院2019年4月~2020年4月收治的78例老年股骨颈骨折患者为例，采用骨水泥型单髋关节置换治疗的39例患者为对照组，采用骨水泥型全髋关节置换治疗的39例患者为观察组。
结果：对照组手术时间少于观察组，治疗效果低于观察组；两组患者术后并发症无显著差异。
结论：对于老年股骨颈骨折患者的治疗采取骨水泥型单髋关节置换术时，术中出血量少、手术时间较短；而采取全髋关节置换术时，术后患者功能康复效果较好。
二者各有优点，可结合老年患者的情况选择合适的治疗方法。
关键词：股骨颈骨折；骨水泥；单髋；全髋；关节置换股骨颈骨折治疗的关键在于选择合适的治疗方法，髋关节置换术是比较常用的一种手术方法。
但传统的置换术后患者发生内科感染、褥疮等并发症的风险较高，且内固定术治疗时间较长、患者康复速度较慢[1]。
使用骨水泥型髋关节置换术则能够解决以上问题，该方法分为单髋和全髋两种类型，对于二者哪一种治疗方法的优势更为突出还存在争议，本文对此进行研究，分析两种方法的优势，以便患者临床治疗时选择科学的方法。
1资料与方法1.1一般资料78例老年患者，年龄均在65岁以上，最大患者76岁，平均（70.04±5.11）岁；从受伤到手术时间为2d~8d，平均（4.31±0.86）d；合并症有糖尿病、高血压。
同时，排除患有病理性骨折、开放性骨折、髋关节骨性关节炎的患者以及合并精神异常、偏瘫等病症的患者。
此外，根据统计学方法对比两组患者资料，无显著差异。
1.2方法对照组单髋置换术：在老年患者髋关节外侧做手术切口，逐层像内切开，取出股骨头，在小转子上端位置上截取一段骨头，扩充骨髓腔，将骨水泥注入到髓腔中；选择合适的假体置入髓腔中，并且采取合适的措施进行固定。
随后对关节腔进行冲洗，止血处理，安置好引流管，将手术切口缝合。
人工全髋关节置换对比研究
人工全髋关节置换对比研究目的通过对一定病例资料的统计，比较人工全髋关节置换与非骨水泥型半髋置换术治疗老年移位股骨颈骨折的临床疗效。
方法回顾性分析进入我院治疗的69例老年移位股骨颈骨患者。
结果治疗组并发症的发生率和翻修率与对照组无明显统计学差异（P>0.05），治疗组患者的疼痛狀况明显低于对照组且治疗组的髋关节功能评分高于对照组，两组治疗结果有显著性差异（P＜0.01）。
结论人工全髋关节置换术治疗老年移位股骨颈骨折具有更高的安全性和有效性。
Abstract：Objective Basing on the statistical data of a certain case，to compare total hip arthroplasty and non bone cement type semi hip replacement in treating clinical curative effect of senile displaced femoral neck fracture. Methods Retrospectively analysising 69 cases of senile enter the hospital treatment of patients with displaced femoral neck bone. Results In treatment group，the incidence of complications and revision rates and control group had no significant difference （P>0.05），the treatment group the pain of patients was significantly lower than the control group and the treatment group of hip joint function score higher than that of the control group，the treatment in the two groups was significant （P＜0.01）. Conclusion The total hip replacement in treatment of elderly patients with displaced femoral neck fracture with higher safety and effectiveness.Key words：Total hip replacement；Non bone cement type；Semi hip replacement；The revision rate老年人普遍存在不同程度的骨质疏松现象，该类人群在遭受到外力的冲击后，很容易引发老年移位股骨颈骨折，因此，该病为老年骨科临床的常见病[1-2]。
非骨水泥型与骨水泥型全髋置换术治疗强直性脊柱炎髋关节病
非骨水泥型与骨水泥型全髋置换术治疗强直性脊柱炎髋关节病目的探讨针对强直性脊柱炎髋关节病变患者，观察临床分别选择非骨水泥型全髋置换术以及骨水泥型全髋置换术完成治疗后获得的临床效果。
方法随机选择该院2013年2月—2015年2月强直性脊柱炎髋关节病变患者70例。
利用抽签法对所有髋关节病变患者实施随机分组。
C2组（对照组35例）：临床选择骨水泥型全髋置换术进行治疗；C1组（观察组35例）：临床选择非骨水泥型全髋置换术进行治疗。
对比两组患者在Harris评分优良率以及完成手术后出现假体松动概率方面存在的差异。
结果两组患者完成治疗后，在Harris评分方面，C1组优于C2组强直性脊柱炎髋关节病变患者，但差异无统计学意义（P>0.05）；在出现假体松动概率方面，C1组低于C2组强直性脊柱炎髋关节病变患者明显（P ＜0.05）。
结论针对强直性脊柱炎髋关节病变患者，临床选择非骨水泥全髋关节置换术的方法进行治疗，能够有效避免出现假体松动的现象。
[Abstract] Objective To observe the clinical effect of cementless and cement total hip arthroplasty in treatment of ankylosing spondylitis hip joint disease. Methods 70 cases of patients with ankylosing spondylitis hip joint disease treated in our hospital from February 2013 to February 2015 were selected and randomly divided into two groups with 35 cases in each，group C2 were given cement total hip arthroplasty in clinic，group C1 were given cementless total hip arthroplasty in clinic，the differences in the excellent and good rate of Harris score and probability of the appearance of prosthesis loosening after operation of the two groups were compared. Results After treatment，the Harris score of group C1 was higher than that in the group C2，however，there was no obvious difference （P>0.05），the probability of the appearance of prosthesis loosening in group C1 was obviously lower than that in group C2 （P＜0.05）. Conclusion Cementless total hip arthroplasty in treatment of patients with ankylosing spondylitis hip joint disease in clinic can effectively avoid the appearance of prosthesis loosening.[Key words] Cementless total hip arthroplasty；Cement total hip arthroplasty；Ankylosing spondylitis hip joint disease强直性脊柱炎属于脊椎的一种慢性炎症，会对患者的诸多关节造成威胁。
全髋关节置换术股骨柄固定方式的比较-骨水泥and非骨水泥
骨水泥假体手术适应征广泛-1
不同年龄的病人
60岁以上＞80%
小于60岁＜20%
骨水泥假体手术适应征广泛-2
各种髓腔都可以使用
骨水泥假体手术适应征广泛-3
骨质疏松患者，骨生长潜能差，不适合 生物型假体
骨水泥假体术后恢复快
骨水泥固定，术后即刻稳定，恢复快，功能好。
病人，女，51岁
术后X线片
骨水泥或非骨水泥
骨水泥的使用有充分的证据支持！！！
Loosening rate of improved cementing technique
使用改良骨水泥技术的松动率
1.7% at six years 6年 1.7％
Harris & McGann 1986
3% for femoral component 42% of
生理扭力负荷比轴向负荷更 多产生微动可能
31
Taper设计
Acolade
骨水泥与生物型固定效果的评价：
骨水泥固定型：骨水泥固定型假体柄设计要符合股骨解 剖曲度特性，以使得髓腔内假体周围的骨水泥达到均匀的厚 度。
骨水泥与生物型固定效果的评价：
生物型固定： 假体的设计，一方面假体的外形尽可能与股骨近端髓
acetabular cup with minimum 10 yrs follow up
至少10年的随访显示股骨部件3％，髋臼杯42％
股骨柄的金标准 Harris & Mulroy
1990
水泥髋与生物髋翻修率比较
• 术后15年内水泥髋的 表现一直优于生物髋
数据来源：《瑞典人工关节报告》
年轻患者水泥髋与生物髋翻修率比较
骨水泥假体柄
锥性、抛光 第三代骨水泥技术
骨水泥型单髋和全髋关节置换治疗老年股骨颈骨折的疗效比较
骨水泥型单髋和全髋关节置换治疗老年股骨颈骨折的疗效比较余海宁;李海涛【摘要】目的比较骨水泥型单髋和全髋关节置换治疗老年股骨颈骨折的疗效.方法将41例股骨颈骨折患者分为A组(采用单髋关节置换治疗,n=23)和B组(采用全髋关节置换治疗,n=18).比较两组手术时间和术中出血量;术后6、12、24个月采用髋关节Harris评分评价疗效.结果患者均获得24个月随访.手术时间和术中出血量B组均多于A组(P＜0.05).术后6、12、24个月Harris评分优良率B组均高于A 组(P＜0.05).结论治疗老年股骨颈骨折,单髋关节置换术具有手术时间短、出血量少等优点;而全髋关节置换患者术后功能恢复较好.【期刊名称】《临床骨科杂志》【年(卷),期】2019(022)002【总页数】2页(P180-181)【关键词】骨水泥型全髋关节置换;骨水泥型单髋关节置换;股骨颈骨折;老年人【作者】余海宁;李海涛【作者单位】汉中市人民医院骨科,陕西汉中723000;汉中市人民医院骨科,陕西汉中723000【正文语种】中文【中图分类】R683.42;R687.4选择合适的手术方案是治疗老年股骨颈骨折的关键,目前常用的手术方法有骨水泥型单髋关节置换术和全髋关节置换术。
2014年7月～2015年7月,我科采用骨水泥型全髋关节和单髋关节置换术治疗41例老年股骨颈骨折患者,笔者比较两种手术的疗效,报道如下。
1 材料与方法1.1 病例资料排除标准:① 开放骨折;② 病理性骨折;③ 合并髋关节骨性关节炎;④存在影响功能评价的合并症,如偏瘫、精神异常等。
本研究纳入41例,男15例,女26例,年龄65～74(70.1±6.4)岁。
按治疗方法将患者分为两组。
① A组:采用单髋关节置换术治疗,23例,男8例,女15例,年龄65～74(70.3±6.5)岁;合并症:高血压6例,糖尿病9例;伤后至手术时间3～7(4±1) d。
非骨水泥全髋关节置换术疗效评估和大腿痛临床研究
非骨水泥全髋关节置换术疗效评估和大腿痛临床研究目的：探討对髋关节疾病行非骨水泥全髋关节置换术（THA）的治疗效果，并观察单侧置换与双侧置换的区别。
方法：选取2007年7月-2013年10月于本院行髋关节置换术治疗的240例髋关节疾病患者作为研究对象，根据置换方案的不同分为单侧置换组180例与双侧置换组60例，对两组患者进行为期2年的随访，比较两组手术前、手术后6、12、24个月的髋关节Harris评分与大腿疼痛目测类比评分，并观察两组末次随访治疗效果。
结果：两组同一时期的髋关节Harris 评分及大腿疼痛目测类比评分比较差异均无统计学意义（P>0.05）。
但与手术前相比，两组手术后6、12、24个月的髋关节Harris评分均明显提高，大腿疼痛目测类比评分均明显降低，差异均有统计学意义（P＜0.05）。
单侧置换组末次随访时髋关节治疗优良率为94.44%，高于双侧置换组的90.00%，但两组比较差异无统计学意义（P>0.05）。
结论：对髋关节疾病患者行非骨水泥全髋关节置换术，可有效改善患者髋关节功能，提高患者生活质量；单侧置换与双侧置换对髋关节疾病的治疗效果均较好，两者治疗效果无明显差异。
由于我国老年人口增多，股骨头缺血坏死与股骨颈骨折的发病率呈逐年上升趋势，大多数患者需行全髋关节置换术治疗。
全髋关节置换假体包括骨水泥型与非骨水泥型两种，但骨水泥型THA的治疗效果不理想，且术后5～8年失败率较高，约为28%～48%，失败后进行翻修的难度较大，而且骨水泥具有毒性作用[1-2]。
非骨水泥全髋关节置换术不但避免了骨水泥的毒性作用，以及假体翻修所带来的麻烦，而且具有手术时间短、创伤小、假体固定牢固等优点，因此，受到了医生的肯定[3]。
但经过临床实践发现，非骨水泥全髋关节置换术后，患者出现大腿痛的几率增加。
如何才能有效改善大腿痛成为困扰临床研究者的一大难题。
本次研究以240例髋关节疾病需行非骨水泥全髋关节置换术治疗的患者作为研究对象，以探讨非骨水泥全髋关节置换术的治疗效果与大腿疼痛情况，现将结果报道如下。
人工全髋关节置换术不同固定方式的术后效果比较
人工全髋关节置换术不同固定方式的术后效果比较摘要目的探究人工全髋关节置换术不同固定方式的术后效果。
方法接受人工全髋关节置换术治疗的患者68例，随机分成对照组和实验组，各34例。
对照组采用生物学固定技术，实验组推行骨水泥固定技术，对比两组术后效果。
结果实验组髋关节功能恢复优良率88.24%高于对照组55.88%，差异具有统计学意义（P＜0.05）。
结论人工全髋关节置换术中应用骨水泥固定技术的临床效果优于生物学固定技术，值得临床积极借鉴。
关键词人工全髋关节置换术；生物学固定技术；骨水泥固定技术；术后效果目前，临床研究证实人工全髋关节置换手术效果主要取决于手术过程中应用的固定方法，而临床常用固定方法主要包括生物固定法及骨水泥固定法[1]。
为了深入探究人工全髋关节置换术不同固定方式的术后效果，本文主要对本院收治的68例行人工全髋关节置换术治疗的患者行对照研究，相关报告如下。
1 资料与方法1. 1 一般资料本组选择本院2012年6月～2013年12月收治的行人工全髋关节置换术治疗的患者68例为研究对象，其中男34例，女34例，年龄58～84岁，平均年龄（70.06±2.14）岁；44例股骨颈骨折，24例股骨粗隆间骨折。
将其随机分成对照组和实验组，各34例。
两组患者一般资料对比差异无统计学意义（P>0.05），具有可比性。
1. 2 方法两组均行人工全髋关节置换术，在手术过程中，实验组应用骨水泥固定法，择取患者侧卧位，行全身麻醉，于手术部位作一个切口（S-P 型），诱导髋关节暴露后行股骨头切除，将碎骨块完全清除，留取股骨距1.0 cm 左右；接着，加深髋臼，诱导髓腔扩大后行冲洗、止血处理，继后安装假臼体及假体柄；待安装位置无误后，向髓腔内作加压处理，行骨水泥填塞，促使假臼体前倾10°、外倾40°，并行引流管放置，逐层进行切口缝合。
对照组实施生物型固定法，待髓腔清洗后安装假臼体及假体柄，未应用粘合剂。
中年患者生物型全髋置换和骨水泥全髋置换的效果分析
中年患者生物型全髋置换和骨水泥全髋置换的效果分析目的探讨中年患者生物型全髋置换和骨水泥全髋置换后的效果比较。
方法2008年3月～2010年3月来本院治疗髋骨的患者，采用生物型全髋置换的中年患者为A组，采用骨水泥全髋置换的中年患者为B组，每组50例。
结果A 组中治疗很满意的患者为42例，2例患者不满意；B组患者很满意为30例，不满意的有6例。
A组中有2例患者的全髋置换处出现松动，B组有6例患者有髋骨松动、髋骨疼痛等多发不良症状。
结论随访比较分析发现，生物型全髋置换的治疗效果更好，患者的满意度高，值得临床推广。
标签：中年患者生物型全髋置换；骨水泥全髋置换；随访比较；效果分析全髋置换手术的类别以臀中肌为分界线，大致可以分为三种：第一种为经臀中肌前方置换，第二种为经臀中肌置换，第三种为经臀中肌后方置换[1]。
这三种手术入路的选择取决于主治医生的习惯，不影响病情。
全髋置换手术已经日趋完善，在人工的主要髋骨治疗中有骨水泥与非骨水泥两种治疗方法[2]，近年来随着技术的发展，其应用较为广泛，人们的追求已经从可以治愈发展到怎样使治愈的效果更好，因此，需要对生物型全髋置换与骨水泥全髋置换的效果进行分析，从而选择最优的治疗，因此，本院进行了此实验，报道如下：1 资料与方法1.1 一般资料选择2008年3月～2010年3月来本院治疗的骨科患者，生物型全髋置换治疗的患者为A组，用骨水泥全髋置换的患者为B组，每组抽取50例患者；A组男26例，女24例，年龄45～71岁，中位年龄为（56.3±1.2）岁；B组男27例，女23例，年龄45～72岁，中位年龄为（56.3±1.4）岁；每组均有股骨颈骨折患者35例，股骨头无菌性坏死15例，均属于单侧全髋置换，两组患者的一般资料比较差异无统计学意义（P > 0.05），具有可比性，对两组患者术后6个月、术后1年进行随访调查，并且邀请患者来医院进行检查复诊，通过患者自我满意和实际恢复情况比较两组的差异。
高龄股骨颈骨折采用骨水泥型人工半髋或全髋关节置换治疗的效果比较
高龄股骨颈骨折采用骨水泥型人工半髋或全髋关节置换治疗的效果比较安占天;王伟;穆亮;韩金龙【摘要】目的：探讨高龄股骨颈骨折患者分别采用骨水泥人工半髋和全髋关节置换进行治疗的疗效差异。
方法选取86例高龄股骨颈骨折患者，按照手术治疗的不同将其分为骨水泥人工半髋关节置换组（甲组）与骨水泥人工全髋关节置换组（乙组），各43例。
比较两组患者的手术时间、治疗的优良率等之间的差异。
结果甲组的手术时间、术中出血量、术后下床活动时间均少于乙组（P＜0.05）；甲组的并发症发生率和治疗优良率略低于乙组，但差异无统计学意义（P＞0.05）。
结论人工全髋关节置换治疗高龄股骨颈骨折疗效略好，较适合于身体状况较好的患者，骨水泥人工半髋关节置换适合于体条件较差者。
%Objective To explore the efifcacy difference of the treatment of senile femoral neck fracture between by cemented artiifcial hemiarthroplasty and by artificial total hip arthroplasty.Methods 86 cases of senile femoral neck fracture were selected and divided into group A(cemented artificial hemiarthroplasty) and group B(artiifcial total hip arthroplasty) with 43 cases respectively. Comparison the difference of two groups with operation time, the treatment good rate et al.Results The operation time, blood loss, postoperative ambulation time of group A were less than group B (P<0.05); the incidence of complications and the treatment good rate were slightly lower than Group B, but the difference was not statistically signiifcant (P>0.05).Conclusion Cemented artiifcial hemiarthroplasty for the treatment of femoral neck fractures was slightly better, so it was more suitable forhealthier patients; cemented artiifcial hemiarthroplasty was suitable for those with poor body condition.【期刊名称】《中国医药指南》【年(卷),期】2016(014)007【总页数】2页(P16-16,17)【关键词】高龄股骨颈骨折;骨水泥型人工半髋关节置换;人工全髋关节置换【作者】安占天;王伟;穆亮;韩金龙【作者单位】新疆兵团第十三师红星医院，新疆哈密839000;新疆兵团第十三师红星医院，新疆哈密839000;新疆兵团第十三师红星医院，新疆哈密839000;新疆兵团第十三师红星医院，新疆哈密839000【正文语种】中文【中图分类】R687.3股骨颈骨折是指发生在股骨头下至股骨颈基底部的骨折，宜在做好充分准备的前提下行人工髋关节置换术。
骨水泥型与生物型全髋关节置换术治疗老年股骨颈骨折的疗效对比
骨水泥型与生物型全髋关节置换术治疗老年股骨颈骨折的疗效对比目的对比骨水泥柄和生物柄人工全髋关节置换术治疗老年股骨颈骨折的临床疗效。
方法收集2011年6月～2013年6月在我院骨科接受人工全髋关节置换术治疗的62例老年股骨颈骨折患者，按照患者意愿，32例为骨水泥组，30例为生物型，观察两组患者手术耗时、术中失血量、围手术期并发症、术后下地时间及Harris髋关节功能评分。
结果两组在术中失血量、术后下地时间及Harris 髋关节功能评分方面比较差异无统计学意义（P>0.05），但生物型组在手术耗时、围手术期并发症方面均优于骨水泥组，差异比较有统计学意义（P＜0.05）。
结论针对老年股骨颈骨折患者，生物柄可能更适合老年股骨颈患者实施全髋关节置换术。
标签：骨水泥柄；生物柄；全髋关节置换术；老年股骨颈骨折随着全球逐渐步入老龄化社会，股骨颈骨折已经成为老年人常见的疾病之一，其发病率呈逐年上升趋势[1]，老年股骨颈骨折采用保守治疗容易发生骨折部位不愈合、股骨头缺血性坏死及肺部感染、血栓等并发症，严重影响患者的生活质量。
随着医学技术及内固定材料的不断发展，人工髓关节置换术在治疗老年股骨颈骨折方面取得了较好的临床疗效，逐渐成为公认的较为理想的治疗手段[2]。
现阶段，骨水泥柄和生物柄人工髋关节置换术已经广泛应用于老年髋关节疾病的治疗，两种治疗方式的疗效一直是广大骨科医师所关注的问题。
为了更好地评价两者的临床疗效，笔者对我院62例老年股骨颈骨折采用以上两种材料治疗的临床疗效进行对比分析，现报道如下。
1 资料与方法1.1一般资料选取2011年6月～2013年6月我院骨科收治的60例采用人工全髋关节置换术治疗的62例老年（年龄≥60岁）股骨颈骨折患者，其中男38例，女24例，年龄60～84岁，平均（71±2.6）岁，骨折类型采用Garden分型法[3]：I型9例，Ⅱ型18例，Ⅲ型22例，Ⅳ型13例，所有患者均通过影像学确诊，并排外病理性骨折、陈旧性骨折、严重心肺功能不全、凝血功能障碍等患者，根据患者意愿分为骨水泥组32例和生物型组30例，所有患者均由同一组手术医师完成，在性别、年龄及骨折类型等方面比较两组差异无统计学意义（P>0.05），资料具有可比性。
(英)骨水泥与非骨水泥初次全髋置换哪个最好？
CLINICAL RESEARCHWhat Works Best,a Cemented or Cementless Primary Total Hip Arthroplasty?Minimum 17-year Followup of a Randomized Controlled TrialKristoff Corten MD,Robert B.Bourne MD,FRCS(C),Kory D.Charron Dipl.MET,Keegan Au MD,FRCS(C),Cecil H.Rorabeck MD,FRCS(C)Received:29November 2009/Accepted:23June 2010/Published online:13July 2010ÓThe Association of Bone and Joint Surgeons 12010AbstractBackground Total hip arthroplasty (THA)has been associated with high survival rates,but debate remains concerning the best fixation mode of THA.Questions/purposes We conducted a randomized con-trolled trial (RCT)with 250patients with a mean age of 64years between October 1987and January 1992to compare the results of cementless and cemented fixation.Patients and Methods Patients were evaluated for revi-sion of either of the components.One hundred twenty-seven patients had died (51%)and 12(4.8%)were lost to followup.The minimum 17-year followup data (mean,20years;range,17–21years)for 52patients of the cementless group and 41patients of the cemented group were available for evaluation.Results Kaplan-Meier survivorship analysis at 20years revealed lower survival rates of cemented compared with cementless THA.The cementless tapered stem was asso-ciated with a survivorship of 99%.Age younger than65years and male gender were predictors of revision surgery.Conclusions The efficacy of future RCTs can be enhanced by randomizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs.Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required.A minimum 10-year followup should be anticipated,but this can be expected to be longer if the difference in level of quality between the compared implants is smaller.Level of Evidence Level I,therapeutic study.See Guidelines for Authors for a complete description of levels of evidence.IntroductionDuring the early 1980s,with THA becoming a much more established procedure,concerns surrounding the use of cement fixation started to surface.The longevity of the first-generation cementing techniques was being ques-tioned,especially for young,active patients [12,17,50,60,62].The more frequent occurrence of osteolysis,which in retrospect was erroneously attributed to ‘cement disease’,promoted the renewed interest in improved cementing techniques,improved cemented stem designs with different surface roughness and implant geometry,and in cementless fixation with ingrowth or ongrowth of bone to the stem.The first generation of cementless femoral stems produced mixed survivorships with problems being related to fixation failure,thigh pain,wear,and osteolysis [9,11,15,18,51].Subsequent generations of uncemented femoral stems have been developed to address these complications and have achieved longevity at least comparable to that of their cemented counterparts with 10or more years of followupEach author certifies that he or she has no commercial associations (eg,consultancies,stock ownership,equity interest,patent/licensing arrangements,etc)that might pose a conflict of interest in connection with the submitted article.Each author certifies that his or her institution approved the human protocol for this investigation,that all investigations were conducted in conformity with ethical principles of research,and that informed consent for participation in the study was obtained.Electronic supplementary material The online version of this article (doi:10.1007/s11999-010-1459-5)contains supplementary material,which is available to authorized users.K.Corten,R.B.Bourne (&),K.D.Charron,K.Au,C.H.RorabeckLondon Health Sciences Centre,University Campus,339Windermere Road,London,ON N6A 5A5,Canada e-mail:robert.bourne@lhsc.on.caClin Orthop Relat Res (2011)469:209–217DOI 10.1007/s11999-010-1459-5[1,2,19,21,22,29,39,43,46,48].The authors of one paper suggested arthroplasties performed without cement were preferable to those with cement,especially in younger,more active individuals[53].To date,there is no consensus on the bestfixation mode for THA.In Sweden, most surgeons prefer to use cementfixation,whereas in North America and Australia,most surgeons prefer cementlessfixation except when patients have severe osteoporosis or Dorr C-type morphologic features of the femur[3,24,27,30,37,38,47,63].Nonetheless,THA is reportedly one of the most cost-effective operations[52].A RCT seemed to be the best way to determine whether cemented or cementlessfixation was superior in THA,min-imizing selection bias and other confounding variables[35, 52].We initiated such a RCT in1987for patients with osteoarthritic hips who met strict inclusion criteria.A THA system with a similar geometry and alloy for cemented and cementlessfixation was chosen.At that time,titanium alloy was thought to provide the bestfixation,also for cemented THA[6,35,52].Short-term followup analyses at a minimum of2years(2-5years)clearly showed the efficacy of cemented and cementless THAs in relieving pain and restoring function[52].However,at midterm followup (mean,6.3years),issues such as increased polyethylene wear and loosening of the cemented and cementless acetabular sockets and the cemented stem were observed[35].Because many patients undergoing THA live20or more years after their surgical procedure,long-term followup is critical.The purpose of this study was to present longer-term followup of our RCT and to answer the following ques-tions:(1)which mode offixation,cemented or cementless, provided the best long-term overall socket and stem implant survivorship;(2)were there patient(age and gen-der),surgeon,or implant factors associated with poorer outcomes;and(3)were there lessons that we might learn from this unique RCT with up to22years of followup? Patients and MethodsThe study was performed between October1987and January1992[35,52].Briefly,patients with any age between18and75years were eligible for the study if they had osteoarthritis of the hip and were undergoing a uni-lateral primary THA that was performed by the two senior surgeons(RB,CR)using a direct lateral approach(Sup-plemental Table1.Supplemental Website Materials; supplemental materials are available with the online ver-sion of CORR).Randomization was computer-generated and stratified by surgeon.At initiation of the study,a total sample size of300patients was calculated to provide80% power to detect a difference between the two groups of 3.25points or greater in the Harris hip score and10%in the 10-year revision rate[35].Patients were evaluated for revision of either of the components and for availability to followup at a minimum of17years.If the patients did not have a minimum17-year followup,they either were con-tacted by phone or the family physician was contacted for information regarding revision status and survivorship of the patient.Patients who had revision surgery of only one component,thereby leaving the other component in place, also were evaluated for the same criteria to determine the status of the retained component.We obtained prior approval of the Institutional Review Board of our hospital and all patients had signed informed consent for partici-pation in the study.A total of250patients were randomized to either a cementless(N=126)(Fig.1)or cemented(N=124)Death (4)R adiographicfollowup(19)Noradiographicfollowup (7)Death (62)Lost tofollowup (7) Randomized (N = 250)Cementless (126)Aseptic revision (31) No revision (95) Radiographicfolllowup (23)followup (4) Lost toFig.1An overview of the fol-lowup for patients in the cement-less group is shown.210Corten et al.Clinical Orthopaedics and Related Research1(Fig.2)THA (Supplemental Table 1.Supplemental Website Materials;supplemental materials are available with the online version of CORR).The patient demo-graphics in both groups were comparable at the time of randomization and at final followup (Supplemental Table 2.Supplemental Website Materials;supplemental materials are available with the online version of CORR)[35].The minimum followup was 17years (mean,19.5years;range,17–22years).One hundred twenty-seven patients had died (51%),and 12(4.8%)were lost to fol-lowup.Fifty-five female patients (47%)had died in comparison to 73male patients (55%)(p =0.098)at a mean of 13years (range,1–21years)after the index pro-cedure.The percentage of patients who had died differed between age groups.Greater than 80%of the patients who were older than 70years at the time of surgery had died,whereas the death rate of the 50-to 65-year-old patient population varied from 10%to 35%.Thirty-one patients (12%)refused to continue with all of the health-related quality-of-life followups,but they continued to attend our regular followup clinics.Minimum 17-year followup data for 12patients (4.8%)with a primary THA were not available and these patients were considered lost to fol-lowup.At initiation of the study,53%of all data were from patients 65years or older,but at final followup,only 36%of all available data were from patients 65years or older (Fig.3).The data of only 14%(older than 70years)to 35%(65–70years)of patients 65years or older were still available at final followup,whereas the data of 50%to 70%of patients between 50and 65years of age were available for evaluation at a minimum of 17years.After 17years,60%of the available data were from patients between 50and 65years at the time of surgery (Fig.3).The minimum 17-year followup data for 52patients of the cementlessgroup and 41patients of the cemented group were avail-able.Their mean age at final followup was 80years (range,61–96years).Results for deceased patients and those lost to followup were not included as failed results in the sur-vivorship analysis.The Mallory-Head total hip system (Biomet,Warsaw,IN,USA)seemed ideal for a RCT because the distinct cemented and cementless components were inserted with common instrumentation [6].Both surgeons were experi-enced hip surgeons and had been using both systems before the presented study [46].Both femoral stems were made from titanium (Ti)alloy.The ultrahigh-molecular-weight polyethylene (UHMWP)used was sterilized by gamma-in-air sterilization.All femoral heads were 28mm in diameter and fabricated from Ti alloy hardened by ion implantation,a technique popular in 1987.The cemented acetabular socket was nonmodular and backed with a Ti alloy metal backing.The modular,cementless,HexLox acetabularRadio follo Mallo stem revisedsocket (8)Revision: aseptic (46) + infection (2)ographic owup of ory-Head with a Radiog follo revision stem + cup graphic owup, (18)DeathRandomized (N = 250)Cemented (124)h (8)Lost t followup (14)to Radio g raphicfollowup No revision (76)(13)Noradiographicfollowup (5)Death (53)Lost to followup (5)Fig.2An overview of the fol-lowup for patients in the cemented group isshown.Fig.3An age group representation at the beginning of the study and at final followup is shown.Volume 469,Number 1,January 2011Randomized Controlled Trials on THA 211component featured a Ti alloy shell and nonhemispheric UHMWP/shell interface.The cementless acetabular and femoral components had a plasma spray ongrowth surface.At initiation of the study,patients were requested to attend the clinic every2years after thefirst postoperative year.Patients were assessed using validated disease-specific scores of which the Harris hip score was used throughout the followup period[35].AP radiographs of the pelvis and cross-table lateral radiographs of the hip were made preoperatively and at each ponent stability and wear of the polyethylene liner were assessed by one observer(KC)according to previously described criteria[13,23,25,26,29,31,36,40,45,46].A cementless stem was considered unstable if there was progressive subsidence or a circumferential radiolucent or radiodense line around the porous coating[31,45,46].A cemented stem was considered unstable in the presence of cement cracks,subsidence,or fracture of the stem[22,23]. The stem was classified as possibly loose if only radiolu-cent lines without migration were present[25,26,36].The location of radiolucent lines around the cup was recorded in the three zones as described by DeLee and Charnley [13].The radiolucent lines were categorized as no radio-lucency or radiolucency greater than2mm[29].Osteolysis was defined as a circular or oval area of distinct bone loss. Evidence of migration was measured on two consecutive radiographs.The acetabular component was considered loose if there was3mm or greater migration from either the interteardrop or vertical lines,or a change of4°or greater in the abduction angle[40].The cup was consid-ered possibly loose if there were radiolucent lines in the three zones without migration being seen on two consec-utive radiographs.The different research questions were evaluated with the following statistical methods:(1)Similar to the Australian National Joint Replacement Registry,we made the distinc-tion between major(component)and minor revisions(liner and head exchange)[3].The Kaplan-Meier(K-M)predicted survivorship method was used to generate survivorship curves with95%confidence intervals and to determine predicted cumulative survivorship at5,10,15,and20years. Cox regression and K-M were used repeatedly with multiple end-point variables:any revision THA,aseptic revision THA,aseptic acetabular cup revision,aseptic femoral stem revision,and aseptic liner/head exchange.(2)As with the Australian National Joint Replacement Registry,age at surgery was dichotomized(younger than65or65years or older)to be analyzed as a categorical variable.Cross-tabu-lation with chi square and Fisher’s exact test was used to determine significance in the distribution of age and gender across THA groups.This statistical method also was used to investigate revision rates across THA group,age category, and gender.Cox regression analysis was performed with THAfixation group,age,and gender as covariates to determine their effect on failure.(3)Based on the revision rates observed in this study,sample size calculations were made to assess the effect of excluding older patients (65years or older)from a future RCT or changing the length of time for which patients are maximally followed up. Sample size calculations were done using nQuery Advisor 5.0(Statistical Solutions,Saugus,MA,USA).Rather than assuming an exponential distribution for the events or dropouts,observed event and dropout rates at1to20years were used as input.Also,it was assumed that patients were followed for afixed time(unless they dropped out early)and that after thisfixed time,patients no longer are followed up, even if the study is still ongoing at that time.Sample size calculations were done using data for the whole population and for patients younger than65years.The calculations also were made for followups of7,10,and15years.The required number of patients per group to achieve80% statistical power when assessing a log rank test at the 5%significance level was calculated.Finally,the Mann-Whitney U test for nonparametric data was used to deter-mine differences in Harris hip score outcome between the two THA groups.ResultsSeventy-nine of the238hips available for followup(33%) were revised.The survivorship of cementless THA was significantly better than cemented THA from the10-year followup term(p=0.020)(Supplemental Table3.Sup-plemental Website Materials;supplemental materials are available with the online version of CORR).Forty-two of 42(100%)cementless stems and23of24(96%)primary cementless sockets were radiographically stable at a min-imum of17years.Twenty of21(95%)cemented stems were radiographically stable whereas only four of eight (50%)surviving cemented cups were radiographically stable after more than17years.None of the implants was revised for instability problems.Cemented THA,age younger than65years at the time of surgery,and male gender predicted higher risk of revi-sion and lower survivorship(Table1).Age was associated with the largest risk of revision(p\0.001;risk=3.21). Considering only aseptic socket revisions,age was the only predictor for an increased risk of revision(p=0.035;risk= 9.39)indicating that patients younger than65years at the time of surgery were9.39times more likely to undergo a major socket revision.Cemented stemfixation(risk=2.3) and younger age(risk=2.5)were predictors for stem failure.None of the covariates were predictive for liner/ head exchange.Age at the time of surgery significantly influenced the revision rates of the THA systems with212Corten et al.Clinical Orthopaedics and Related Research1significantly more revisions in the younger age group (p\0.001)(Table2).In this age group,cementless sockets had significantly lower major revision rates(p=0.01) (Table3).In the older age group,there was no difference in revision rates between groups(Supplemental Table4. Supplemental Website Materials;supplemental materials are available with the online version of CORR).The cementless stems had significantly lower failure rates regardless of age at the time of surgery(Table3).The overall revision rates between genders were similar (Supplemental Table5.Supplemental Website Materials;supplemental materials are available with the online ver-sion of CORR).In males,the K-M survivorship of cementless stems was better(p\0.001).However,the survivorship of both THA systems was similar(p=0.4) owing to the similar survivorships of the sockets(p=0.2) (Table4).In females,the survivorship of the cementless THA was better(p=0.001)on the femoral and acetabular sides(Table4).Sample size calculations were made using data for the whole population(aged18–75years)and for patients younger than65years.The required number of patients perTable1.Cox regression analysis of cementedfixation,age,and gender as risk factors for revisionVariables All aseptic revisionTHRs Aseptic acetabular cuprevisionsAseptic femoral stemrevisionsAseptic liner/headexchangesSignificance level Risk*SignificancelevelRisk*SignificancelevelRisk*SignificancelevelRisk*THR group(cemented)p=0.006 1.91p=0.937p=0.002 2.3p=0.894Age(\65years)p\0.001 3.21p=0.0359.39p=0.001 2.54p=0.239Gender(male)p=0.011 1.83p=0.064p=0.051p=0.465*risk to revision is reported only for variables that were significant in each Cox regression analysis.Table2.Revision rates stratified per age group(\or C65years)Revision rate THR revisions Stem revisions Socket revisions Liner exchanges\65years C65years\65years C65years\65years C65years\65years C65yearsSample size(number)117133117133117133117133 Revisions(number)55361310412081 Revision rate(%)47.0%27.1%11.1%7.5%35.0%15.0% 6.8%0.8% Revision rate significance b p\0.001p=0.383p\0.001p=0.014b=Significance for revision rate determined by two-way cross tabulation with Fisher’s Exact test for significance.Table3.Revision rates for patients younger than65years at time of surgerySurvivorship THR revisions Stem revisions Socket revisions Liner exchanges Cementless Cemented Cementless Cemented Cementless Cemented Cementless CementedRevision rate36.7%57.9%0.0%22.8%23.3%47.4%13.3%0.0% Significancelevel bp=0.040p\0.001p=0.011p=0.006Kaplan-Meiersurvivorship5years10.945±0.03110.945±0.03110.945±0.0311110years0.912±0.0380.795±0.05510.867±0.0470.929±0.0340.849±0.0490.982±0.018115years0.706±0.0620.506±0.07110.770±0.0620.793±0.0560.580±0.0730.890±0.047120years0.557±0.0750.297±0.076310.675±0.0860.714±0.0670.345±0.0840.780±0.0761Significancelevel cp=0.018p\0.001p=0.010p=0.024b=Significance for revision rate determined by two-way cross tabulation with Fisher’s Exact test for significance;c=significance for Kaplan-Mieier survivorship determined by Breslow(generalized Wolcoxon)test of equality of survival distributions.Volume469,Number1,January2011Randomized Controlled Trials on THA213group to achieve80%statistical power when assessing a log rank test at the5%significance level was calculated (Table5).This calculation showed that the number of patients that should be included to detect a difference in survivorship between both THA designs depends on the expected followup period and the age of the patient pop-ulation.Including only patients younger than65years in a RCT that is planned for at least10or15years of followup would require60and40patients,respectively,in each treatment group.However,the numbers would have to be 110and100patients if patients65years or older also are included.DiscussionRCTs are considered the gold standard for study design in evidence-based medicine[28].Despite the lack of con-sensus on the bestfixation mode for THA,we are not aware of any RCT that compared long-term survivorship of two differentfixation modes in THA.The purpose of this study was threefold.First,we compared the long-term survivor-ship of the Mallory-Head THA either implanted with or without cement.Second,we aimed to evaluate which parameters might influence the long-term survivorship of both THA designs.Third,we assessed our long-term experience with this single-center RCT to set up guidelines for any future RCTs on THA.We note several limitations.First,one of the risks of initiating a long-term followup trial of a THA system is that the implant has become obsolete atfinalization of the trial.Moreover,the failure mechanisms observed in this study are implant-specific and related to the knownflaws of the designs used.However,some valid conclusions regarding the long-term survivorship can be drawn.Sec-ond,the calculated sample sizes for future RCTs can be considered as the minimum sample sizes because they are based on the comparison of designs that are in retrospect associated with importantflaws and -paring designs with a higher level of quality can require more patients be included or extending the followup time. Third,a possible criticism is whether the results are gen-eralizable to other cemented or cementless THAs or to all surgeons.However,the identification of gender and age as important variables for implant survivorship are in agree-ment with the intermediatefindings of the registries,which can be considered representative of the orthopaedic com-munity at large[3,38,47].The Ti alloy,tapered stem was associated with an excellent20-year survivorship with only one revision being performed for a periprosthetic fracture.None of the stems was revised for aseptic loosening.With this stem design,a survivorship at least comparable or even better than that of other cementless and cemented stem designs could be achieved[1,2,4,5,7,8,10,21,22,29,32,34,39,43,48, 49,56,58,61,62,64].It generally is accepted that a cemented metal-backed socket,a Ti femoral head,and a Ti alloy cemented stem inserted with a ream-and-broach technique are not optimal features for a cemented design to obtain good long-term survivorship.This also was shown in our study.The cementless socket design had a better survivorship than the cemented socket but less optimalTable4.Revision rates of the stem,socket,and THR system stratified to genderGender THR revisions Stem revisions Socket revisions Liner exchanges Cementless Cemented Cementless Cemented Cementless Cemented Cementless CementedMalesRevision rate32.9%34.9%0.0%19.0%22.9%30.2%10.0%0.0% RR SL b p=0.854p\0.001p=0.330p=0.014 K-M SL c p=0.429p\0.001p=0.226p=0.025 FemalesRevision rate14.0%38.3%0.0%18.3%10.5%33.3% 3.5%0.0% RR SL b p=0.003p=0.001p=0.003p=0.239 K-M SL c p=0.001p=0.001p=0.001p=0.222b=Significance for revision rate determined by two-way cross tabulation with Fisher’s Exact test for significance;c=Significance for Kaplan-Mieier Survivorship determined by Breslow(generalized Wolcoxon)test of equality of survival distributions.RR SL=revision rate significance level;K-M SL=Kaplan-Meier significance level.Table5.Sample size calculations for estimated length of followupsPatient group Length of followup(years)71015All ages included140*110100Only age\65years included135^6340*minimum calculated number of patients that should be included in aRCT with an anticipated followups of7,10,and15years if all agesare included,and when only patients\65years old are included^.214Corten et al.Clinical Orthopaedics and Related Research1results as compared with newer-generation cementless sockets[20,32–34,41,44,57,59].Initial cementlessfix-ation was not the problem,but rather polyethylene wear and periacetabular osteolysis.The use of a single offset stem and a Ti alloy femoral head probably also contributed to the wear rates in our patients[14,16,42,54,55].In this randomized controlled design we found age and gender to be important prognosticators for THA failure. This is in concert with some prospective reports and the registry data,however there were some interestingfind-ings[3,5,47,63].First,we were not able to identify a difference in survivorship of sockets in the older age group.In other words,the cemented socket was more likely to survive the elderly patient,thereby obscuring the real shortcomings of the implant.Thisfinding questions the efficacy of including elderly patients in long-term RCTs.Second,as a group,males did not have higher revision rates than females.However,there were differ-ences betweenfixation modes within gender.The requirements of implants to withstand the activity level of patients thus are gender-specific with the most strenuous requirements being for male patients.As with age,the distinction between genders should be made in reports on THA survivorship.Some lessons can be learned from our RCT.First,only 73%of the calculated patients who had met the inclusion criteria actually participated in the trial.This problem might be easier to overcome in a multicenter trial.Sec-ond,at a minimum of10years,the difference in Harris hip score between groups was greater than3.25,as the study was designed tofind.However,this difference was not significant(p=0.129)because of large variations. This indicates that multiple scores should be used,as the variability is probably score dependent.Third,the goal to identify a difference in survivorship of greater than10% between groups was achieved by no earlier than10years of followup.The difference in survivorship between the stems was apparent at an early followup interval of 6years[35],but because the cementless socket also has nonoptimal features,it took10years before the survi-vorship of the cementless THA was better than the cemented THA.This followup term might even be markedly longer in case one would be comparing implants with improved design features.Fourth,older patients generally have lower activity levels and they are more likely to die before implant failure.Only26%of all revisions were in the age group65years or older.We conclude that the efficacy of this RCT would have been greater if only patients younger than65years would have been included because50%fewer patients would have been recruited without changing the conclusions of the study.However,the life expectancy of the contemporary patient population probably is higher than that of the same patient cohort from20years ago.We hypothesize that also including patients between65and70years of age probably would not decrease the efficacy of a future RCT.We found that cementless tapered stems were associated with an excellent20-year survivorship.We suggest that future projects can be enhanced by randomizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs to speed up the recruitment process. Including only patients younger than65to70years might improve the efficacy of a RCT as this would require a considerably smaller patient cohort with the highest risk for revision and the best chance for long-term followup availability.A minimum10-year followup period should be anticipated.Improving the efficacy of a RCT is not only cost-and time-efficient but also minimizes the number of subjects that are exposed to any potential risks orflaws associated with the investigated implants. Acknowledgments We thank Andreas Laupacis for his outstanding work in setting up this study.We also thank Ann Belmans,depart-ment of Biostatistics,KU Leuven,Belgium,for excellent support and advice in the statistical evaluations of this study.References1.Aldinger PR,Jung AW,Breusch SJ,Ewerbeck V,Parsch D.Survival of the cementless Spotorno stem in the second decade.Clin Orthop Relat Res.2009;467:2297–2304.2.Aldinger PR,Jung AW,Pritsch M,Breusch S,Thomsen M,Ewerbeck V,Parsch D.Uncemented grit-blasted straight tapered titanium stems in patients younger thanfifty-five years of age:fifteen to twenty-year results.J Bone Joint Surg Am.2009;91: 1432–1439.3.Australian Orthopaedic Association.National Joint Replace-ment Registry Annual Report2008.Available at:http://www..au/aoanjrr/publications.jsp?section=reports 2008.Accessed January6,2009.4.Belmont PJ Jr,Powers CC,Beykirch SE,Hopper RH Jr,Engh CA Jr,Engh CA.Results of the anatomic medullary locking total hip arthroplasty at a minimum of twenty years:a concise follow-up of previous reports.J Bone Joint Surg Am.2008;90: 1524–1530.5.Berry DJ,Harmsen WS,Cabanela ME,Morrey BF.Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements:factors affecting survivorship of acetabular and femoral components.J Bone Joint Surg Am.2002;84:171–177.6.Biomet Inc.Product Information Manual,Mallory-Head TotalHip Arthroplasty.Warsaw,IN:Biomet Inc;1990.7.Bourne RB,Rorabeck CH,Patterson JJ,Guerin J.Tapered tita-nium cementless total hip replacements:a10-to13-year followup study.Clin Orthop Relat Res.2001;393:112–120.8.Buckwalter AE,Callaghan JJ,Liu SS,Pedersen DR,Goetz DD,Sullivan PM,Leinen JA,Johnston RC.Results of Charnley total hip arthroplasty with use of improved femoral cementing techniques:a concise follow-up,at a minimum of twenty-five years,of a previous report.J Bone Joint Surg Am.2006;88: 1481–1485.9.Callaghan JJ,Dysart SH,Savory CG.The uncemented porous-coated anatomic total hip prosthesis:two-year results of aVolume469,Number1,January2011Randomized Controlled Trials on THA215。
骨水泥型与非骨水泥型人工全髋关节置换术的比较
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节 病 患者 行 人工 髋关 节 置换 术 ， 中男 ２ 其 ８例 ３ ０个 髋 （ 中 ２例为双 髋 ） 女 ２ 其 。 ４例 ２ ４个 髋 ； 年龄 ６ ～ ２ ５ ８
人工全髋关节置换骨水泥和无骨水泥假体术后疗效及假体可能的生存率比较
人工全髋关节置换骨水泥和无骨水泥假体术后疗效及假体可能的生存率比较张勇;杨彤涛;周勇;马保安【期刊名称】《中国组织工程研究》【年(卷),期】2006(010)013【摘要】背景:人工关节置换者最关心的是人工假体寿命.目的:回顾性方法综合评价人工全髋关节置换术骨水泥和无骨水泥假体术后疗效,以期为延长人工关节的寿命提供经验.设计:随机对照观察.单位:第四军医大学唐都医院全军骨肿瘤研究所、全军骨科中心.对象:解放军第四军医大学唐都医院骨科1993-03/2004-03行人工全髋关节置换术患者356例,获得通讯联系的298例,获得随访105例(108髋),均自愿回访,性别不限,假体类型2000年以前为国产假体,使用国产骨水泥,2000年以后使用美国STRIKER公司的假体,骨水泥由该公司提供.骨水泥中均加有钡剂.患者手术全部由经考核进入人工关节组的医生进行.方法:参照1982年中华外科髋关节人工置换座谈纪要及Mayo人工髋关节疗效评价表,自行设计随访信,对105例(108髋)患者进行随访,其中骨水泥组62例(63髋),无骨水泥组43例(45髋),并对术后患者在疼痛、功能、关节活动范围及X-ray片进行综合性评价和分析.主要观察指标:①患者术后疼痛程度.②患者术后髋关节功能情况.③患者术后关节活动范围.④患者假体周围透亮线、假体水平或垂直移位的距离.⑤患者假体异位骨化的范围.⑥患者股骨近端骨溶解程度.结果:①随访期股前外侧疼痛两组差别不显著[骨水泥组24髋(38.5%),无骨水泥组18髋(40.0%)1.②随访期两组均有跛行.③随访期患者髋关节活动范围160°以上两组无显著差异(骨水泥组62髋,无骨水泥组44髋).④股骨假体的下沉和髋臼假体的水平、垂直移位两组患者中差别不显著.⑤随访期骨水泥组股骨近端骨密度相对值57.4(9～118),无骨水泥组股骨近端骨密度相对值72.8(14～130),差别不显著.⑥两组患者术后疗效及假体可能生存率,股骨近端广泛骨溶解无显著差异.结论:无论骨水泥假体还是无骨水泥假体患者术后疗效相似,假体都没有达到理想固定的效果.假体类型的选择并不影响假体的寿命,要根据患者的年龄及是否还要行翻修术来决定假体类型;骨溶解与患者年龄、性别、假体类型无关.%BACKGROUND: Patients who suffered total hip replacement are most concerned about the survivorship of prosthesis. OBJECTIVE: To evaluate the postoperative curative effect following ce mented and cementless THR with a retrospective method, so as to provide experience for prolonging the survivoship of prosthesis. DESIGN: Randomized and controlled observation. SETTING: General Center of Orthopaedic Department, General Institute of Bone Oncology, Tangdu Hospital, Fourth Military Medical University of Chinese PLA. PARTICIPANTS: We admitted 356 patients who underwent THR from Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical U niversity of Chinese PLA between March 1993 and March 2004. Among them, 298 were contacted and 105 (108 hips) followed up. The patients participated in the review voluntarily. They were of either gender and had different types of prosthesis. Prosthesis made in China was adopted before 2000 and prosthesis made in American STRIKER company after 2000: Prosthesis made in China was made of home-made bone cement; Prosthesis bone cement (import) was provided by American STRIKER prosthesis company. Home-made bone cement and import have the same components. Barium was added in both bone cement . The whole operation was con ducted by the physicians whoworked in the artificial joint department after examination. METHODS: According to informal discussion summary about total hip replacement of Chinese Journal of Surgery in 1982 and Evaluation Scale of Mayo Total Hip Replacement Curative Effect, we designed follow-up table by ourselves. Totally 105 (108 hips) patients were followed up, among them, 62 (63 hips) were in the cemented group, 43 (45 hips) in the ce mentless group. Pain, function and motion range of the patients and X-ray were evaluated and analyzed respectively. MAIN OUTCOME MEASURES: ① Postoperative pain degrees. ② Postoperative function of hips. ③ Postoperative motion r ange.④ width of light around the prothesis , distance of horizontal or vertical shift of the prosthesis. ⑤ range of ectopic ossification of the prosthesis.⑥Osteolysis degree of proximal femur. RESULTS: ①There was no significant difference of lateral femoral pain during follow-up period [Cemented group: 24 hips (38.5%) ,cementless group: 18 hips(40.0% )]. ② Limping appeared in the both two groups ③ There was no significant difference of range of motion above 160° between two groups (Cemented group: 62 hips; cementless group: 44 hips). ④There was no significant difference in subsidence of femoral prosthesis and hori zontal or vertical shift of acetabular prosthesis between two groups . ⑤ There was no significant difference of re lative value of femoral proximal bone density between cemented group [57.4(9-118)] and cementless group [72.8( 14-130)]. ⑥There was no significant difference of postoperative cu rative effect, possible survival rate of prosthesis and femoral proximal ex tensive osteolysis of the patients between the two groups. CONCLUSION:Postoperative curative effect of the patients between ce mented group and cementless group are similar, both not obtaining an ideal fixed effect. The choice of prosthesis type does not affect the survivorship of prosthesis, but it depends on the age of patients to decide whether rebuilding is necessary or not: Osteolysis is not related to age, gender or prosthesis type of the patients.【总页数】3页(P187-189)【作者】张勇;杨彤涛;周勇;马保安【作者单位】解放军第四军医大学唐都医院骨科,陕西省,西安市,710038;解放军第四军医大学唐都医院骨科,陕西省,西安市,710038;解放军第四军医大学唐都医院骨科,陕西省,西安市,710038;解放军第四军医大学唐都医院骨科,陕西省,西安市,710038【正文语种】中文【中图分类】R681.6【相关文献】1.人工全髋关节置换男性和女性患者术后疗效及假体可能生存率比较 [J], 张勇;杨彤涛;周勇;马保安2.人工全髋关节置换骨水泥和无骨水泥假体股骨近端广泛骨溶解定… [J], 张勇;李稔生3.人工全髋关节置换骨水泥和无骨水泥假体股骨近端广泛骨溶解的定量分析 [J], 张勇;杨彤涛;周勇;马保安4.女性患者使用及未使用抗骨质疏松药物人工全髋关节置换术后疗效及假体可能生存率比较 [J], 张勇;杨彤涛;周勇;胡运生;李存孝;马保安5.人工全髋置换骨水泥和无骨水泥假体术后疗效及假臼可能生存率比较 [J], 张勇;杨彤涛;周勇;马保安因版权原因，仅展示原文概要，查看原文内容请购买。
骨质疏松症患者全髋关节置换术假体选择骨水泥或非骨水泥型假体
《中华骨与关节外科杂志》2020年9月第13卷第9期Chin J Bone Joint Surg，Sep.2020，Vol.13,No.9骨质疏松症患者全髋关节置换术假体选择：骨水泥或非骨水泥型假体*张庆李甲朱善邦徐卫东**（海军军医大学附属长海医院关节骨病外科，上海200433）【摘要】随着中国进入老龄化社会，骨质疏松症的发病率越来越高，进而出现了大量骨质疏松性骨折。
无论是因老年骨质疏松性髋部骨折导致的全髋关节置换术（THA），还是单纯合并骨质疏松症的THA，骨质疏松症正成为影响THA 成败的重要问题。
高龄骨质疏松症患者进行THA时选择骨水泥型假体还是非骨水泥型假体仍尚存争议。
本文回顾近年来国内外相关文献，对骨质疏松症患者THA的假体选择进行综述。
【关键词】骨质疏松症；髋关节置换术；骨水泥型假体；非骨水泥型假体Selection of prosthesis for osteoporosis patients receivingtotal hip arthroplasty:cemented or non-cemented*ZHANG Qing,LI Jia,ZHU Shanbang,XU Weidong**(Department of Orthopaedics,Changhai Hospital,The Naval Military Medical University,Shanghai200433,China)【Abstract】As the aging society coming in China,the incidence of osteoporosis is getting higher and higher,which leads to a large number of osteoporotic fractures.Osteoporosis is becoming an important problem affecting hip replacement whether with osteoporosis or due to osteoporotic hip fracture.For the elderly patients with osteoporosis requiring artificial joint replace‐ments,it is still controversial to choose the cement prosthesis or the non-cemented prosthesis.Through review of recent arti‐cles home and abroad the selection of THA prosthesis for osteoporosis patients was summarized.【Key words】Osteoporosis;Hip Replacement;Cemented Prosthesis;Non-Cemented Prosthesis近年来，骨质疏松症已经成为影响人类健康的全球性问题。
人工全髋关节置换术治疗股骨颈骨折非骨水泥型与骨水泥型的疗效对比
人工全髋关节置换术治疗股骨颈骨折非骨水泥型与骨水泥型的疗效对比黄云【期刊名称】《陕西医学杂志》【年(卷),期】2004(033)009【摘要】目的:股骨颈骨折患者行人工全髋关节置换术治疗时非骨水泥型与骨水泥型的疗效对比.方法:应用瑞典米他保公司人工髋关节假体及手术器械,对72例股骨颈骨折患者施行全髋关节置换,其中非水泥型人工全髋关节53例,水泥型19例.临床随访根据Harr is的评分方法进行评分.结果:临床随访Harris评分术后3年平均95分,5年平均89分,7.5 年平均83分,Harris评分低于85分者6例.术后2例髋臼假体松动,但仅限于X线所见,临床上尚无症状,3例术侧肢体深静脉栓塞,经溶栓、抗凝治疗后症状消失.目前尚无行翻修手术的病例.结论:应用人工全髋关节置换术(THR)是治疗股骨颈骨折的有效治疗手段,其疗效显著,并发症少,很大程度改善了病人关节功能,提高了术后生活质量.【总页数】3页(P790-792)【作者】黄云【作者单位】青海省人民医院骨科,西宁810007【正文语种】中文【中图分类】R6【相关文献】1.老年股骨颈骨折采用骨水泥型与非骨水泥型半髋治疗临床疗效对比分析 [J], 李灿辉;吴景雄;李青天;洪小泳2.人工全髋关节置换术与非骨水泥型半髋置换术治疗\r老年移位股骨颈骨折的对比研究 [J], 刘志军;高翔;尧剑波3.骨水泥型与非骨水泥型双极股骨头假体置换治疗高龄股骨颈骨折合并骨质疏松症的临床效果评价 [J], 谢辉; 王本杰; 赵德伟4.骨水泥型与非骨水泥型人工半髋关节置换术治疗高龄股骨颈骨折患者的对比研究[J], 焦力刚;张雷;王卫友5.骨水泥型与非骨水泥型人工半髋关节置换术治疗高龄股骨颈骨折患者的对比研究[J], 焦力刚;张雷;王卫友因版权原因，仅展示原文概要，查看原文内容请购买。