人工髋关节置换术与骨折内固定术治疗老年股骨颈骨折的对比分析

目的对比分析人工髋关节置换术和骨折内固定术治疗老年股骨颈骨折的临床疗效，评价不同术式的优劣。方法回顾性分析2000年7月-2008年6月我院收治的60岁以上的股骨颈骨折患者118例，其中人工股骨头置换42例，全髋关节置换40例，内固定36例。对三组患者的术前合并症、手术时间、术中失血量、住院时间、卧床时间、再手术率、术后并发症等临床指标以及术后患侧髋关节功能评价进行统计学分析。结果随访2～8年，平均4．3年。三组患者术前合并症、早期并发症方面差异无统计学意义（P〉0．05），而住院时间、手术时间、术中失血量、卧床时间、远期并发症方面差异有统计学意义（P〈0．05）。内固定及人工股骨头置换中远期并发症及再手术率高，而全髋关节置换早期并发症多，但随访时髋关节功能优良率高。结论GardenⅠ、Ⅱ、Ⅲ型的70岁以下老年股骨颈骨折患者，在优良复位的前提下可行内固定术；人工股骨头置换适合65岁以上、全身情况较差的患者；全髋关节置换适合60～80岁、体质较好的患者。

Comparison study of Arthroplasty and Internal Fixation for Treatment of Femoral Neck Fracture in Elderly Patients

Objective To comparatively analyze the clinical effects of artificial joint replacement and internal fixation for treatment of femoral neck fractures in aged patients and evaluate the merits and defects of different methods. Methods To retrospectively analyze 118 cases （ over 60 years old） with femoral neck fractures treated in our hospital from July 2000 to June 2008, of which 42 cases were treated with femoral head arthroplasty（ Group FHA）,40 with total hip joint replacement（ Group THR） and 36 with internal fixation（ Group IF）. The clinical data of the three groups such as the preoperative coexisting diseases, duration of operation, intraoperative blood loss, duration of hospitalization, ambulation time, secondary surgery rate, postoperative complications and the function evaluation of affected hip joint after operation were collected for statistical analysis. Results The average follow - up time was 4.3 years ranged from 2 years to 8 years. In comparison of the preoperative coexisting diseases and early stage complication, there was no significant difference between the three groups （ P 〈 0. 05 ）. While in comparison of the duration of hospitalization, duration of operation, intraoperative blood loss, ambula- tion time, forward stage complication and the function evaluation of affected hip joint, there was a significant difference （ P 〈 0. 05 ）. Internal fixation and femoral head arthroplasty had higher rate of middle -forward stage complications and secondary surgery. And total hip joint replacement had more ccomplications at the early stage, but its function was better. Conclusion While treating femoral neck fracture of Gardens Ⅰ ,Ⅱ of Ⅲ in the elderly （60 -70 years old）, internal fixation should be the first choice, femoral head arthroplasty is suitable for the patients of over 65 with systemic diseases, and total hip joint replacement is suitable for the patients arranged from 60 to 80 with excellent constitution.