螺钉内固定、股骨头置换与全髋关节置换治疗老年移位型股骨颈骨折的疗效比较

目的 比较螺钉内固定术、股骨头置换术与全髋关节置换术(THA)治疗老年移位型股骨颈骨折的疗效。方法 回顾性分析2013年5月—2018年5月长治医学院附属和平医院骨科280例老年移位型股骨颈骨折患者的临床资料。根据手术方式的不同分为3组,其中行螺钉内固定术76例为A组,男32例、女44例,年龄(70.95 ±8.24)岁;行股骨头置换术92例为B组,男40例、女52例,年龄(72.84 ±9.14)岁;行THA 112例为C组,男59例、女53例,年龄(73.05 ±7.21)岁。比较三组患者术中出血量、手术时间、术后并发症发生情况及术后12个月髋关节功能Harris评分。结果 A组术中出血量、手术时间及骨折愈合时间分别为(95.05±20.14)mL、(47.06±10.14)min、(6.64±1.74)个月,B组分别为(208.74±60.15)mL、(82.55±15.47)min、(5.01±1.25)个月,C组分别为(337.69±85.13)mL、(97.85±12.04)min、(4.36±1.04)个月。术中出血量和手术时间比较,B组、C组均大于A组,C组大于B组;骨折愈合时间比较,B组、C组均短于A组,C组短于B组:差异均有统计学意义(P值均＜0.05)。3组患者均获随访,随访时间12~60(39.45±8.25)个月。三组间并发症发生率比较,B组(20.65%,19/92)、C组(16.07%,18/112)均小于A组(38.16%,29/76),差异均有统计学意义(P值均＜0.05),而C组与B组间差异无统计学意义(P＞0.05)。术后12个月采用Harris评分评定髋关节功能,A组、B组、C组优良率分别为63.14%(48/76)、75.00%(69/92)、83.93%(94/112),C组优良率明显高于A组(P＜0.05),而B组与A组、C组间差异均无统计学意义(P值均＞0.05)。结论 对老年移位型股骨颈骨折患者,应综合考虑患者身体耐受程度、个人意愿等因素,选择合适且安全的手术方式。对身体状况相对较好,且对活动能力要求较高的患者,可采取THA,该术式的疗效优于股骨头置换术与加压螺钉内固定术。

Comparison of screw fixation,femoral head replacement and total hip replacement in the treatment of displaced femoral neck fractures in the elderly

Objective To compare the efficacy of screw fixation, femoral head replacement and total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in the elderly.Methods The clinical data of 280 elderly patients with displaced femoral neck fractures from May 2013 to May 2018 in Peace Hospital Affiliated to Changzhi Medical College were retrospectively analyzed. According to the different surgical methods, 76 cases were treated with screw fixation in group A, among them, there were 32 males and 44 females, with the average age of (70.95±8.24) years old. And 92 cases with replacement of femoral head in group B, among them, 40 males and 52 females, with the average age of (72.84±9.14) years old. And 112 cases with THA in group C, among them, 59 were males and 53 were females, with the average age of (73.05±7.21) years old. The general data, intraoperative bleeding volume, operation time, complications and Harris score of hip function after surgery were compared among the three groups.Results Intraoperative blood loss, operation time and fracture healing time in group A were (95.05±20.14) mL, (47.06±10.14) min and (6.64±1.74) months, respectively. In group B, they were was (208.74±60.15) mL, (82.55±15.47) min and (5.01±1.25) months, respectively. In group C, they were (337.69±85.13) mL, (97.85±12.04) min and (4.36±1.04) months, respectively. In the comparison of intraoperative hemorrhage and operation time, group B and C were greater than group A, group C was greater than group B; in the comparison of fracture healing time, group B and group C were shorter than group A, and group C was shorter than group B; the difference was statistically significant (all P values＜0.05). All the patients were followed up for 12-60 (39.45±8.25) months. The incidence of complications in group B (20.65%, 19/92) and group C (16.07%, 18/112) were lower than that in group A (38.16%, 29/76), the difference was statistically significant(all P values＜0.05), but there was no significant difference between group C and group B (P＞0.05). Twelve months after operation, Harris score was used to evaluate the hip joint function. The excellent and good rates of group A, B and C were 63.14% (48/76), 75.00% (69/92) and 83.93% (94/112), respectively. The excellent and good rates of group C were significantly higher than those of group A (P＜0.05), but there was no significant difference between group B and group A, C (all P values＞0.05).Conclusions For elderly patients with displaced femoral neck fractures, appropriate and safe surgical procedures should be selected with comprehensive consideration of the patient's physical tolerance, personal intention and other factors. THA is suitable for patients with relatively good physical condition and high mobility requirements, and the effect of THA is better than that of femoral head replacement and compression screw fixation.