目的 探讨初次人工全髋关节置换术不同固定方式对假体生存的影响。方法 收集2000-04至2013-11武警陕西总队医院骨科初次人工全髋关节置换术且需要翻修病例146例,根据固定方式分为骨水泥固定组(61例),非骨水泥固定组(85例),进行回顾性分析,对初次人工全髋关节置换术后两种固定方式的假体生存时间进行Kaplan-Meier生存分析。结果 两组患者初次行人工全髋关节置换手术时的年龄无统计学差异(P=0.4287),骨水泥固定组假体生存时间0.5～240个月,平均(75.741±7.507)个月;非骨水泥固定组假体生存时间0.3～228个月,平均(67.656±6.689)个月。两组病例假体生存时间差异无统计学意义(P＞0.05)。结论 初次人工全髋关节置换中,骨水泥固定类形假体生存时间与非骨水泥固定类型假体生存时间无统计学差异,两种固定方式对假体生存无影响,翻修风险相同,临床效果相同。
Abstract
Objective To investigate the effect of different fixation methods on the survival of prosthesis in primary total hip arthroplasty. Methods From 2000 to 2013, 146 cases of primary total hip arthroplasty requiring revision in the Department of Orthopedics of Shaanxi Provincial Corps Hospital of Chinese People’s Armed Police Force were collected, and divided into bone cement fixation group (61 cases) and cementless fixation group (85 cases) according to fixation methods. Kaplan-Meier survival analysis was performed to evaluate the survival time of two fixed prostheses after primary total hip arthroplasty. Results There was no statistically significant difference in the age between the two groups at the time of initial total hip replacement (P=0.428).Kaplan-Meier survivorship of cement prosthesis was 0.5-240 month, with an average of (75.741±7.507) months. The survival time of prostheses in the cementless group was 0.3-228 month, with an average of (67.656±6.689) months.There was no significant difference in the survival time between cement and cementless prosthesis after primary total hip arthroplasty. The results didn’t have statistical significance (P＞0.05). Conclusions There is no statistical difference between the survival time of cement-fixed prostheses and that of cementless-fixed prostheses in the primary total hip arthroplasty. The two fixation methods have no effect on the survival of prostheses. The revision risk is the same and the clinical effect is the same.
关键词
全髋关节置换术 /
骨水泥 /
非骨水泥 /
生存分析
Key words
total hip arthroplasty /
cement /
cementless /
survival analysis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Prokopetz J J, Losina E, Bliss R L,et al.Risk factors for revision of primary total hip arthroplasty: a systematic review [J].BMC Musculoskel Dis, 2012, 13:251.
[2] Ulrich S D, Seyler T M, Bennett D, et al.Total hip arthroplasties: what are the reasons for revision? [J].Int Orthop,2008,32(5):597-604.
[3] Meding J B, Ritter M A, Davis K E,et al. Cemented and uncemented total hip arthroplasty using the same femoral component[J]. Hip Int,2016,26(1):62-66.
[4] Kubinec V.Influence of the type of hip-component fixation and age of patients on mid-term revision rate of total hip replacement[J]. Acta Chir Orthop Traumatol Cech,2018,85(1):46-53.
[5] Cassar-Gheiti A J, McColgan R, Kelly M, et al.Current concepts and outcomes in cemented femoral stem design and cementation techniques: the argument for a new classification system[J]. EFORT Open Rev,2020,5(4):241-252.
[6] Hooper G J, Rothwell A G, Stringer M,et al. Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry[J].J Bone Joint Surg Br, 2009, 91(4):451-458.
[7] Hailer N P, Garellick G, Kärrholm J. Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register[J]. Acta Orthop,2010,81(1):34-41.
[8] Lie S A, Fenstad A M, Lygre S H L, et al. Kaplan-meier and cox regression are preferable for the analysis of time to revision of joint arthroplasty: thirty-one years of follow-up for cemented and uncemented thas inserted from 1987 to 2000 in theNorwegian Arthroplasty Register[J]. JBJS Open Access,2022,7(1):e21.00108.
[9] Mäkelä K T, Matilainen M, Pulkkinen P, et al. Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations[J]. BMJ,2014, 13:7592.
[10] Bloemheuvel E M, van Steenbergen L N, Swierstra B A. Comparable mortality but higher revision rate after uncemented compared with cemented total hip arthroplasties in patients 80 years and older: report of 43053 cases of the Dutch Arthroplasty Register[J]. Acta Orthop,2022,93:151-157.
[11] Jämsen E, Eskelinen A, Peltola M, et al. High early failure rate after cementless hip replacement in the octogenarian[J]. Clin Orthop Relat Res,2014,472(9):2779-2789.
[12] Morshed S, Bozic K J, Ries M D, et al. Comparison of cemented and uncemented fixation in total hip replacement.a meta-analysis[J]. Acta Orthop,2007,78(3):315-326.
[13] Clement N D, Linden M, Keating J F. Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip fractures: a randomised controlled trial of 50 patients[J]. Eur J Orthop Surg Traumatol, 2021,31(3):587-594.
[14] Yang C, Han X, Wang J, et al.Cemented versus uncemented femoral component total hip arthroplasty in elderly patients with primary osteoporosis: retrospective analysis with 5-year follow-up[J]. J Int Med Res, 2019,47(4):1610-1619.
[15] Raja B S, Gowda A K S, Singh S, et al. Comparison of functional outcomes and complications of cemented vsuncemented total hip arthroplasty in the elderly neck of femur fracture patients: a systematic review and meta-analysis[J]. J Clin Orthop Trauma,2022,22(29):101876.
[16] Hanif M, Arshad N, Habib Y, et al. Effect of cementing technique on aseptic stem loosening in cemented primary total hip arthroplasty: a systematic review and meta-analysis[J]. Ann Med Surg (Lond),2023, 85(6):2884-2895.
[17] Kuijpers M F L, Hannink G, Steenbergen L N,et al.Total hip arthroplasty in young patients in the netherlands: trend analysis of >19000 primary hip replacements in the Dutch arthroplastyregister[J]. J Arthroplasty,2018,33(12):3704-3711.
[18] Zhang C, Chen M, Yu W, et al.Long-term survival after cemented versus uncemented total hip arthroplasty for treatment of acute femoral neck fracture: a retrospective study with a mean 10-year follow-up[J]. J Int Med Res, 2020,48(9).
[19] de Martino I, de Santis V, D′Apolito R, et al. The Synergy cementless femoral stem in primary total hip arthroplasty at a minimum follow-up of 15 years[J]. Bone Joint J, 2017,99 (1):29-36.
[20] Park J W, Ko Y S, Park S, et al. Cemented versus cementless total hip arthroplasty for femoral head osteonecrosis: a study based on national claim data in south korea[J].J Am Acad Orthop Surg Glob Res Rev,2023,7(5):e23.00029.
[21] Melbye S M, Haug S C D, Fenstad A M, et al. How does implant survivorship vary with different corail femoral stem variants? Results of 51212 cases with up to 30 years of follow-up from the Norwegian Arthroplasty Register[J].Clin Orthop Relat Res,2021,479(10):2169-2180.
[22] Tanzer M, Graves S E, Peng A, et al.Is cemented or cementless femoral atem fixation more durable in patients older than 75 years of age? A comparison of the aest-performing stems[J]. Clin Orthop Relat Res,2018,476(7):1428-1437.
PDF(946 KB)
