| Objective:With the development of society and living standard in China and the extension of life expectancy,the incidence of hip fracture in elderly patients is annually increasing,meanwhile the number of hip arthroplasty is also gradually increasing.At the same time,with the prolongation of the life-span of the prosthesis,the hip arthroplasty has made great progress and been more and more recognized clinically.The good effects of clinical are that it can relive the pain for the majority of patients,improve the hip function,and improve the standard of life.Hip prosthesis can be divided into cement type and cementless type.With the problem of cement prosthesis gradually appearing,and the advantages of cementless femoral prosthesis are shorter operation time,comparatively intraoperative patient safety,mode of biological fixation and less surgery trauma,and avoid the adverse effect of cement produced in the process of injection and the difficulty of postoperative hip revision,bony destruction phenomena.Compared with cement hip prosthesis,cementless femoral prosthesis has been accepted by more and more clinicians and widely used in clinical.In this article,the relevancy between the effects after hip cementless prosthesis replacement for femoral neck fracture and morphology of proximal femoral medullary cavity will be discussed.Whether the varieties of proximal femoral medullary cavity with the different curvature tolerances between prosthesis and medullary cavity,are related to the incidence rate of intraoperative periprosthetic fracture and the effects of the patient after operation.Because no single type of prosthesis is suitable for all patients,we need to have a thorough understanding of each type of prosthesis,including its strengths and weaknesses,to make the appropriate choice based on the patient’s needs.Through the study on the correlation between the postoperative clinical efficacy of cementless prosthesis replacement and the morphology of the proximal femoral medullary cavity,get to know the relevant factors and improve the preoperative plan,so as to improve the long-term effect of hip arthroplasty and reduce the relevant complications.Methods:In this study,a retrospective clinical analysis was used to study the data of46 patients(46 hips)with femoral neck fracture admitted to the hospital where I worked,who received biological hip hemiarthroplasty from January 2018 to January 2020.The average age of the patients was(76.96±8.55)years.There were 13 males and 33 females,Garden II:1 case,Garden III:33 cases;Garden IV : 12 cases.Four parameters of diameter of proximal femoral medullary cavity and three parameters of medullary cavity morphology were measured by DICOM Viewer software.Analyze the correlation between the various parameters of proximal femoral with gender,age.According to CFI 、MCFI,classify the morphology of proximal femoral medullary cavity.Analysis the epiphyseal filling rate in different proximal femoral geometry in different classification of CFI,MCFI,postoperative imaging data,Harris score,VAS score and relevant indicators of clinical outcome and complications,analyze and evaluate the differences in clinical effects and complications of patients with different medullary cavities after biological hip hemiarthroplasty.Data were processed and analyzed with SPSS24.0 statistical software.P<0.05 was considered statistically significant,and P<0.01 was considered obvious statistically significant.Results:he mean age of the patients was(76.96±8.55)years,including 13 males and 33 females.According to Nobel’s classification of proximal femoral medullary cavity,Normal type 39 cases(possessed 84.78%),the chimney type5 cases(possessed 10.87%)and champagne type 2 cases(possessed 4.35%).In13 cases of men,champagne type 0 cases,normal type 12 cases(92.31%),chimney type 1 case(7.69%),in 33 cases of women,champagne type 2 cases(6.06%),normal type 27 cases(81.82%),chimney type 4 cases(12.12%).CFI(3.66±0.50),MCFI(2.04±0.26),isthmus medullary cavity width(mm)(13.10±2.42),isthmus height(cm)(11.52±1.70),metaphyseal filling rate(84.01±5.63).The metaphyseal filling rate was(84.33±5.44)for the normal type and(84.61±6.57)for the chimney type and(76.27±2.43)for the champagne type.The metaphyseal filling rates of MCFI groups(< 1.8,1.8-2.4,> 2.4)were83.65±5.78,84.60±5.48,80.92±6.51,respectively.Among all the patients,there were 4 intraoperative periprosthetic fractures(3 females,1 male),which made the rate of 8.70%.According to the Vancouver classification,2 cases were AL type and 2 cases were AG type,all of which were fixed with steel wire or steel cable.All of them healed well up to the last follow-up.At the last follow-up after surgery,there were 40 patients(4died and 2 lost to follow-up).The average Harris score was(84.73±7.48),the excellent and good rate was 86.96%,and the average VAS score was(1.34±0.94).Harris score of normal type(84.94±7.84),VAS score(1.27±0.98),Harris score of chimney type(81.20±3.70),VAS score(1.40±0.89),Harris score of champagne type(90.00±5.66),VAS score(1.50±0.71).Among 40patients(40 hips)who received early postoperative follow-up(1 year),the preoperative mean Harris scores of patients with medullary cavity morphology:normal type,chimney type and champagne pouring type was 35.6、36.6 and39.7.The average Harris scores followed-up one year after surgery was 84.9,81.2 and 90.0 respectively,significantly higher than that of preoperatively.According to the ratings of excellent(90～100 points),good(80～89 points),general(70～79 points)and poor(69 points),excellent and good rate of surgical results were 83.87%、80.00%、100%.5 patients developed thigh pain symptoms,the incidence rate was 12.5%,1 case was I degree;4 cases were II degree,including 2 cases of chimney type(II degree),with an incidence of 40%,and 3cases of normal type(1 case of I degree,2 cases of II degree),with an incidence of 9.09%.Death cases within 1 year after operation: 4 cases,mortality rate: 8.69%,and all the morphology of medullary cavity were normal.All patients could relieve their pain by taking anti-inflammatory and analgesic drugs without affecting their autonomous walking and walking distance.The overall effect of hip arthroplasty with biological femoral prosthesis was satisfactory in the early stage,and there was no significant difference in the follow-up results.Postoperatively,there was no significant difference in the complications of dislocation,infection,lower limb DVT and other complications among the three different morphology of proximal femoral medullary cavity.By the last follow-up,no femoral prosthesis was revised.Conclusion:(1)There are significant variations in the morphology of proximal femoral medullary cavity and the dominating factors mainly included age and gender.(2)The treatment strategy of cementless hip hemiarthroplasty for femoral neck fracture should take the morphology of proximal femoral medullary cavity into account.(3)There were no significant differences of clinical efficacy and complications of three types of morphology of proximal femoral medullary cavity in the 1-year follow-up after cementless hip arthroplasty. |
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