三种手术方法治疗脑血管意外后偏瘫侧股骨颈骨折的比较

目的 比较空心钉内同定、双动人工股骨头置换和人工全髋关节置换术对偏瘫侧股骨颈骨折的治疗效果.方法 2002年9月至2007年2月间收治脑血管意外偏瘫后股骨颈骨折患者共67例,回顾性分析患者的一般资料、伤前状况、骨折与偏瘫侧的父系、骨折距离腩血管意外发生的时间等.对其中偏瘫侧骨折的65例患者分别进行闭合复位空心螺钉内固定(11例)、双动人工股骨头置换(37例)和人工全髋关节置换术(17例).比较三种治疗方法在手术时间、出血量、下地行走时间、住院时间、围手术期并发症等方面的差异,观察早期并发症的发生以及随访期内死亡病例的情况. 结果本组患者中97.0%(65/67)的股骨颈骨折发生在偏瘫侧;所有患者伤前均能行走;除1例外,致伤原因均为跌倒摔伤;骨折距离脑血管意外发生的时间平均为1年3个月.三组的手术时间(F=45.952,P=0.000)、出血量(F=47.795,P=0.000)和下地时间(F=331.922.P:0.000)间差异均有统计学意义.与人工股骨头置换和全髋关节置换组相比,内固定组的手术时间短、手术出血量低、下地行走时间长,差异均有统汁学意义(P<0.05).人工股骨头置换组的手术时间短于全髋关节置换组,差异有统计学意义(P<0.05),但下地时间差异无统计学意义(P>0.05).三组的住院时间(F=0.217,P=0.806)和围于术期并发症的发生率(χ<'2>=2.090,P=0.352)差异无统计学意义.术后平均随访2年2个月(6个月～4年5个月),无严重早期并发症发生,随访期内9例患者死亡.结论 脑血管意外后股骨颈骨折多发生于能够行走的偏瘫患者的偏瘫侧,致伤原凶主要是跌倒摔伤.闭合复位内同定、人工股骨头置换和全髋火节胃换术对偏瘫侧股骨颈骨折的治疗各有其优势,应根据骨折类型和患者具体情况进行个体化治疗.

Treatment of femoral neck fractures of hemiplegic extremities after stroke

Objective To compare the therapeutic effects of reduction and internal fixation with hollow-screws, bipolar femoral head replacement and total hip arthroplasty (THA) for femoral neck fractures of hemiplegic extremities after stroke. Methods Included in this study were 67 patients with post-stroke fractures of femoral neck hospitalized from September 2002 to February 2007. Such data as age, gender, physical activity before fracture, side of fracture, causes of fracture and time interval between fracture oc-curling and stroke onset, were collected. Sixty-five patients with femoral fractures of hemiplegie extremities were treated with close reduction and internal fixation (11 cases), bipolar femoral head replacement (37 cases) and THA (17 cases), respectively. Differences in operation time, blood loss, days between operation and ambulation, hospitalization days, perioperative complications were compared between the 3 treatment groups. Short-term complications and postoperative mortality were observed. Results Patients were followed up for a mean of 2 years and 2 months. All but one fractures were caused by falls and 65 femoral neck fractures affected the paralytic side. The median time between stroke onset and femoral neck fracture was 15 months. All patients could walk with or without walkers before fractures. Internal fixation had longer operation time, more blood loss and longer bed-ridden time than femoral head replacement and THA (P < 0.05). The bipolar femoral head replacement had shorter operation time than THA (P < 0.05), but no difference in bed-ridden time (P > 0.05). There was no significant difference in hospitalization time and incidence of peri-operative complications between the 3 groups. Totally 9 patients died and no severe short-term complications happened during the follow-up period. Conclusions Post-stroke femoral neck fractures are mostly caused by fall and will affect independently mobile patients with hemiplegic extremities. Because close reduction with internal fixation, femoral head replacement and THA have advantages over each other in treating femoral neck fractures of hemiplegic extremities, individualized treatment is suggested for the patients according to their spe-cific fracture type and health condition.