İleri Yaş Hastalarda Çimentolu ve Çimentosuz Hemiartroplasti Sonuçlarının Karşılaştırılması

Year 2017, Volume: 44 Issue: 3, 233 - 241, 20.09.2017

Şehmuz Kaya Hüseyin Özdemir Abdullah Yalçın Dabak

https://doi.org/10.5798/dicletip.338986

Cited By: 1

Abstract

Amaç:  Bu   çalışmada
 ileri   yaş   hastalarda
 çimentolu  ve 
 çimentosuz
 hemiartroplasti  sonuçlarını
 ve   birbirine
üstünlüklerini değerlendirdik.

Yöntemler: Bu çalışma femur boyun kırığı nedeni ile takip edilen ve hemiartroplasti cerrahisi uygulanan toplam 86
hastadan düzenli kontrollere gelip kayıtları tutulan 46 hastanın dahil edildiği retrospektif bir çalışmadır. Bu hastaların

28’ine çimentosuz, 18’ine çimentolu hemiartroplasti yapılmıştı.

Bulgular:
 Çimentosuz  hemiartroplasti
 operasyonu
 yapılmış  hastaların
 ortalama  yaşı
 71,3  (yaş  aralığı
 50 -94),
çimentolu hemiartroplasti yapılmış grupta ise 86 (yaş aralığı 58-104)’ tü. Broker’in myoziti değerlendirmek için tarif ettiği sınıflandırmaya göre çimentolu bipolar hemiartroplasti yapılan 10 (%55,5) hastada myozit
görüldü. Çimentosuz bipolar hemiartroplasti yapılan 6 (%21,4) hastada
myozit görüldü. Çimento uygulanan 18 hasta ile uygulanmayan 28 hasta arasında harris skoru açısıdan anlamlı fark yoktu (p=0.339).
Ayrıca iki grup arasında femoral stem gevşemesi ve stem migrasyonu
açısından anlamlı fark yoktu (p>0.05). Heterotropik ossifikasyon açısından iki grup arasındaki fark
ise anlamlı idi (p<0.05). İki grup arasındaki perioperatif mortalite oranları karşılaştırıldığında sementli
hemiartroplasti yapılan grupta mortalite oranları daha yüksek bulunmuştur.

Sonuç: İleri yaştaki hastalarda sementsiz kalça protezinin özellikle ameliyat esnasında hastaya minimum tr avma
yaşatması, mortaliteyi anlamlı bir şekilde düşürmesinden
dolayı bu hastalarda en uygun tedavi yöntemi olduğunu düşünmekteyiz.

Keywords

Çimentolu, çimentosuz

References

• 1. Tarasevicius S, Jermolajevas V, Tarasevicius R, et al. Total hip replacement for the treatment of femoral neck fractures. Long-term results. Medicina. 2005;41:465-9.
• 2. Terry Canale S. Campbell’s operative orthopaedics, 10. Baskı (Türkçe). Istanbul. Hayat Tıp. 2007: 2908-22.
• 3. Lo WH, Chen WM, Huang CK, et al. Bateman bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures. Uncemented versus cemented. Clin Orthop. 1994; 302:75-82.
• 4. Wilson V, Huo MH. Treatment of femoral neck fractures with prosthetic arthroplasty. Curr Opin Orthop. 2004; 15:18-21. 5. Holt EM, Evans RA, Hindley CJ, Metcalfe JW. 1000 femoral neck fractures: the effect of pre-injury mobility and surgical experience onoutcome. Injury 1994;25:91-5.
• 6. Lausten GS, Vedel P. Cementing v. not cementing the Monk endoprosthesis. Injury. 1982; 13:484-8.
• 7. Muirhead-Allwood W, Hutton P, Glasgow MMS. A comparative study of cemented and uncemented Thompson prosthesis. J Bone Joint Surg Br. 1983;65:218.
• 8. Keisu KS, Orozco F, Sharkey PF, et al. Primary cementless total hip arthroplasty in octogenarians: two to eleven-year follow-up. J Bone Joint Surg Am. 2001;83:359-63.
• 9. Khan RJK, MacDowell A, Crossman P, Keene GS. Cemented or uncemented hemiarthroplasty for displaced intracapsular fractures of the hip- a systmatic review. Injury. 2002; 33:13-7
• 10. Lennox IAC, McLauchlan J. Comparing the mortality and morbidity of cementedand uncemented hemiarthroplasties. Injury. 1993; 24:185-6.
• 11. Brooker AF, Bowerman JW, Robinson RA, RileBrooker AF, Bowerman JW, Robinson RA, Riley LH Jr.y LH Jr. Ectopic ossification following total hip replacement incidence and method of classification. J Bone Joint Surg. 1973; 55:1629-32.
• 12. Bölükbaşı S, Uluoğlu Ö, Tecimer T. Intrakapsüler femur kırıklarında hemiartroplasti ve femur başında ve eklem kapsülündeki histopatolojik değişiklikler. Acta Orthop Traumatol Turc. 1992; 26:14-20.
• 13. Bray TJ, Smith-Hoefer E, Hooper A, Timmerman L. The displaced femoral neck fracture, internal fixation versus bipolar endoprosthesis. Results of a prospective randomized comparison. Clin Orthop. 1988; 230:127-40.
• 14. Broos PL, Stappaerts KH, Luiten EJ, Gruwez JA. Endoprosthesis. The best way to treat unsable intracapsular hip fractures in the elderly patient. Unfallchirurg, 1987; 90:347-50.
• 15. D'Arcy J, Devas M. Treatment of fractures of the femoral neck by replacement with the Thompson prosthesis. J Bone Joint Surg. 1976; 58:279-86.
• 16. Hinchey J, Day PL. Primary prosthetic replacement in fresh femoral neck fractures. A review of 294 consecutive cases. J Bone Joint Surg. 1964; 46:223-40.
• 17. Johnson JTH, Crothers O. Nailing versus prosthesis for femoral neck fractures. A clinical review of long term results in two hundred and thirty nine consecutive private patients. J Bone Joint Surg. 1975; 57:686-92.
• 18. Riley TBH. Knobs or screws?. A prospective trial of prosthetic replacement against internal fixation of subcapital fractures. J Bone Joint Surg. 1978; 60:136-141.
• 19. Sikorski JM, Barrington R. Internal fixation versus hemiartroplasty for the displaced subcapital fracture of the femur. A prospective randomised study. J Bone Joint Surg.1981; 63:357-61.
• 20. Söreide O, Mölster A, Raugstad TS. Internal fixation versus primary prosthetic replacement in acute femoral neck fractures: A prospective, randomized clinical study. Br J Surg. 1980; 66:56-60.
• 21. Brown TJ, Abrami G. Transcervical femoral fracture. A review of 195 Patients treated by sliding nail-plate fbcation J Bone Joint Surg. 1964; 46:648-63.
• 22. Parker MJ, Rajan D. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2001;CD001706.
• 23. Anderson LD, Hamsa WR, Waring TL. Femoral head prostheses. J Bone Joint Surg. 1964; 46:1049-65.
• 24. Ong BC, Maurer SG, Aharonoff GB, et al. Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up. J Orthop Trauma. 2002 May;16:317-22.
• 25. Seckin B. Kollum Femoris Kırıklarında Unipolar ve Bipolar Parsiyel Protezlerin Karşılaştırılması. Uzmanlık Tezi. Sağlık Bakanlığı Haydarpaşa Numune Eğitim ve Araştırma Hastanesi, İstanbul, 2003.
• 26. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994;4:368-81.
• 27. Siris ES, Miller PD, Barrett-Connor E, et. al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women results from the National Osteoporosis Risk Assessment. JAMA. 2001;286:2815-22.
• 28. Coates R, Armour P. The Treatment of Subcapital Femoral Fractures by Primary Total hip Replacement. J.Bone and Joint Surg. 1980; 61:336.
• 29. Delamarter R, Moreland JR. Treatment of acute femoral neck fractures with total hip arthroplasty. Clin Orthop.1987; 218:68-74. 30. Dorr LD, Glousman R, Hoy AL, et al. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty. 1986;21-8.
• 31. Muirhead-Allwood W, Hutton P, Glasgow MMS. A comparative study of cemented and uncemented Thompson prosthesis. J Bone Joint Surg Br 1983;65:218.
• 32. Eftekhar NS. Ectopic bone formation: Total hip arthroplasty, 1* ed. Eftekhar NS (ed), Mosby, StLouis, 1993; 1581-1905.
• 33. Gebhard JS, Amstutz HC, Zinar DM, Dorey FJ. A comparison of total hip arthroplasty and hemiarthroplasty for treatment of acute fracture of the femoral neck. Clin Orthop Relat Res. 1992;282:123-31.
• 34. Bhandari M, Devereaux PJ, Swiontkowski MF, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck: a meta- analysis. J Bone Joint Surg Am. 2003;85: 1673-81.
• 35. Kenzora JE, Magaziner J, Hudson J, et al. Outcome after hemiarthroplasty for femoral neck fractures in the elderly. Clin Orthop Relat Res.1998;348: 51-8.
• 36. Anderson G, Dias JJ, Hoskinson J, Harper WM. A randomized study of the use of bone cement with Thompson's prosthesis in the treatment for intracapsular fractures of the femoral neck. J Bone Joint Surg Br. 1992; 74:132.
• 37. Emery RJH, Eroughton NS, Desai K, et al. Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomised trial of cemented Thompson and uncemented Moore stems. J Bone Joint Surg. 1991; 73:322-4.
• 38. Follacci FM, Charnley J. A comparison of the results of femoral head prosthesis with and without cement. Clin Orthop Relat Res. 1969; 62:156-61.
• 39. Hinchey J, Day PL. Primary prosthetic replacement in fresh femoral neck fractures. A review of 294 consecutive cases. J Bone Joint Surg. 1964; 46:223-40.
• 40. Gingras MB, Clarke J, Mc Collister Evarts C. Prosthetic replacement in femoral neck fractures. Clin Orthop. 1980;152:147-57.