老年人移位股骨颈骨折内固定失效后的人工全髋关节置换术

目的 比较分析老年人移位股骨颈骨折内固定失效后行人工全髋关节置换术(total hip replacement,THR)和老年人移位股骨颈骨折后Ⅰ期行THR的临床效果,探讨老年人移位股骨颈骨折的治疗方法. 方法对2001年4月-2007年4月因移位股骨颈骨折内固定失效后接受THR的老年患者16例(研究组)和因移位股骨颈骨折接受Ⅰ期THR的老年患者20例(对照组)全部进行了随访.其中研究组男7例,女9例;年龄50～85岁,平均66.5岁.随访时间24～96个月,平均58.25个月.对照组男6例,女14例;年龄51～83岁,平均68.1岁.随访时间24～70个月,平均49.50个月.36例患者伤前生活能够完全自理并有正常的户外活动.比较分析两组行THR的手术时间、术中出血量;THR术后随访时的患髋关节功能(Harris评分)、卡氏生活质量评分. 结果研究组和对照组具有可比性.研究组THR手术时间(115.66±34.35)min,对照组手术时间(91.25 ±15.80)min(P<0.05);研究组THR术中出血量(546.86 ± 377.04)ml,对照组术中出血量(320.00 ± 155.94)ml(P<0.05);研究组THR术后随访时Harris评分(87.25 ± 7.53)分,卡氏生活质量评分(95.00 ± 5.16)分,对照组THR术后随访时Harris评分(90.20 ± 5.46)分,卡氏生活质量评分(96.00±0.73)分(P>0.05);研究组和对照组均未发生感染和翻修,各有1例患者死亡.结论 老年人移位股骨颈骨折内固定失效后的THR手术风险高于老年人移位股骨颈骨折后Ⅰ期的THR.THR是治疗老年人移位股骨颈骨折的有效方法.

Total hip replacement after failed internal fixation in the elderly patients with displaced femoral neck fractures

Objective To investigate the clinical results of the primary total hip replacement (THR) and the secondary THR after failed internal fixation in the elderly patients with displaced femoral neck fracture so as to find the optimal treatment for displaced femoral neck fractures in the elderly patients. Methods From April 2001 to April 2007,16 patients (Study Group) treated with a secondary THR after failed internal fixation and 20 patients (Control Group) treated with a primary THR were enrolled in the study and followed up. There were seven males and nine females, at average age of 66. 5 years (50-85 years) and with mean follow-up period of 58. 25 months (24-96 months) in the Study Group. There were six males and 14 females, at average age of 68.1 years (51-83 years) and with mean follow-up period of 49.50 months (24-70 months) in the Control Group. All patients were active and lucid before they suffered fractures. Blood loss and operation duration in THR were compared. Hip function (Harris score) and health-related quality of life (HRQoL, KPS index score) were assessed during the follow-up after THR. Results Operative duration was (115.63 ±34.35) minutes in Study Group and (91.25 ±15.80) minutes in Control Group (P<0.05). Blood loss was (546.86 ±377.04) ml in Study Group and (320.00 ±155.94) ml in Control Group (P<0.05). At follow up, Harris score and KPS index score were (87. 25 ±7. 53) points and (95. 00 ±5. 16) points respectively in Study Group, and (90.20±5.46) points and (96.00 ±0.73) points respectively in Control Group (P>0.05). There were no infections or re-operations in two groups, but with one death in each group during the follow-up. Conclusions THR is the optimal treatment for displaced femoral neck fractures in the elderly patients.The secondary THR after failed internal fixation has higher risks in operation compared with the primary THR for a displaced femoral neck fracture in the elderly patient.