双极股骨头与全髋关节置换术的疗效比较

目的 比较老年股骨颈骨折患者实施双极股骨头与全髋关节置换术后的疗效.方法 选用笔者科室2009年5月～2013年5月收治的196名老年股骨颈骨折的患者,分别实施双极股骨头与全髋关节置换术;临床和影像学检查随访4年,手术并发症、髋关节功能及髋臼的侵蚀程度在两组均被记录.结果 随访到第4年时,在双极股骨头置换术组,对患者进行了X线片评估,10人出现了髋臼的侵蚀,占12.0％（10/83）.在随访第4个月时,全髋关节置换术组的髋关节Harris评分优于双极股骨头置换术组,并持续到随访的第4年（P＜0.05）,在随访的第1年时,全髋关节置换术组的髋关节功能评分、髋关节疼痛程度评分及髋关节功能均优于双极股骨头置换术组,并持续到随访的第4年（P＜0.05）.结论 对于老年股骨颈骨折患者的术式选择应遵循个体化原则,对没有认知功能障碍、全身状态较好、预期寿命较长及活动量大的患者可实施全髋关节置换术,术后髋关节功能优于双极股骨头置换术.

Comparison between Bipolar Hemiarthroplasty and Total Hip Replacement

Objective To compare between bipolar hemiarthroplasty and total hip replacement therapy in aged patients with femoral neck fracture.Methods 196 aged patients with femoral neck fracture were chosed in our department from May 2009 to May 2013.All patients were divided into two groups.Patients were respectively implemented bipolar hemiarthroplasty and total hip replacement.Clinical and radiographic inspection were followed-up for 4 years.Surgical complications,hip function and acetabular erosion degree in two groups were recorded.Results Follow-up to the 4 years,patients＇X-ray film in bipolar hemiarthroplasty group were evaluated.Ten patients appeared acetabular erosion which accounted for 12.0％ （10/69）.To follow-up of 4 months,Hip Harris score of total hip replacement group was better than bipolar hemiarthroplasty group.This tred continued to follow-up of 4 years （P ＜ 0.05）.To the follow-up of 1 year,hip function score,hip pain score and the hip function of total hip replacement group was better than bipolar hemiarthroplasty group.This tred continued to follow-up of 4 years （P ＜ 0.05）.Conclusion Treatment of elderly patients with femoral neck fracture should follow the principle of individualization.This suggestes that the hip function of the aged patients with femoral neck fracture who had no cognitive dysfunction,better state of body,longer life expectancy,big activity implemented total hip replacement which is better than bipolar hemiarthroplasty.