髋关节置换术与骨折内固定术治疗新鲜移位的老年股骨颈骨折的疗效对比

目的探讨髋关节置换术与经皮空心钉内固定治疗的临床疗效对比。方法笔者回顾性分析收治的77例新鲜移位的老年股骨颈骨折患者的手术及术后随访资料,根据手术方式分为髋关节置换组40例、内固定组37例(采用经皮空心钉内固定治疗),比较两组患者的手术情况及术后髋关节功能恢复等指标的差异。结果髋关节置换组的手术时间、术中出血量、住院时间、住院费用,术后第3、6个月,末次随访时的Harris评分均显著高于同期内固定置换组患者且差异具有统计学意义(P0.05),下床活动时间显著少于内固定组且差异具有统计学意义(P0.05)。髋关节置换组末次随访时的髋关节功能优良率(92.50%)显著高于内固定组(72.97%)且差异具有统计学意义(P0.05),并发症率(7.50%)显著低于内固定组(24.32%)且差异具有统计学意义(P0.05)。结论髋关节置换术治疗新鲜移位的老年股骨颈骨折较经皮空心钉内固定对患者的髋关节功能恢复具有更好的效果,但是手术时间较长、出血量较大、住院费用较高。

Curative effect comparison of total hip replacement and internal fixation in the treatment of fresh displaced femoral neck fracture in the elderly

Objective To compare the clinical effect of hip joint replacement and percutaneous hollow screw internal fixation .Methods Clinical data of 77 elderly patients with fresh displaced femoral neck fracture were analyzed retrospectively.All cases were divided into the hip replacement group (n=40) and the internal fixa-tion group ( n=37) according to the operation method .Differences in the recovery of hip function and other indexes were compared between the two groups .Results The operation time (98.6 ±7.3)min],blood loss (483.6 ± 57.2)mL],hospitalization time (19.6 ±3.4)d],hospital costs (35089 ±5632)yuan] in the hip replacement group were significantly more than those in the internal fixation group and the differences were statistically significant ( P<0.05) .Harris scores in the first three months ,six months and the last follow-up in the hip replacement group were higher than those in the same period in the replacement group with statistically significant differences ( P<0.05).The ambulation time was (12.8 ±2.5) days in the replacement group , shorter than that in the internal fix-ation group with statistical significance (P<0.05).The excellent and good rate was 92.50% in the hip replace-ment group at the last follow-up,which was significantly higher than that of the internal fixation group (72.97%) and the difference was statistically significant ( P <0.05 ) . The complication rate in the hip replacement group (7.50%) was significantly lower than that of the internal fixation group (24.32%) and the difference was statistically significant(P<0.05).Conclusion Hip replacement for fresh displaced femoral neck fracture has better results than percutaneous cannulated screw fixation .While the operative time ,blood loss and hospital costs are higher .