全髋与半髋关节置换治疗老年股骨颈骨折的疗效比较

目的:比较全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折(GardenⅢ-Ⅳ型)的疗效。方法:分析2009年1月—2011年1月收治的96例≥65周岁的老年股骨颈骨折并行髋关节置换术患者的临床资料。根据采取手术方式的不同,分为全髋关节置换组(46例)与半髋关节置换组(50例)。比较两组患者的手术时间、术中出血量、髋关节功能和切口感染率、假体脱位发生率和翻修率等。结果:全髋关节置换组与半髋关节置换组的手术时间、术中出血量及髋关节功能评分差异有统计学意义(P<0.05)。两组切口感染率、翻修率和假体脱位发生率均较低,差异无统计学意义(P>0.05)。结论:全髋关节置换与半髋关节置换治疗老年股骨颈骨折相比,虽然创伤较大、手术时间较长以及出血量相对较多,但髋关节功能明显优于半髋关节置换术且术后并发症少。临床上应尽量选择全髋关节置换术治疗老年股骨颈骨折(GardenⅢ-Ⅳ型),除非患者不能耐受手术或预期寿命小于5年。

The comparison on effect of total hip arthroplasty and hemiarthroplasty for displaced femoral neck fractures in the elderly

Objective:To compare the effects of total hip arthroplasty and thoses of hemiarthroplasty in treatment of the displaced femoral neck fracture(Garden Types Ⅲ-Ⅳ) in the elderly.Methods:From 2009 to 2011,96 elderly patients of over 65 years old with displaced femoral neck fracture were operated on with total hip arthroplasty(total hip arthroplasty group,46 cases) or hemiarthroplasty(hemiarthroplasty group,50 cases).To observe the operating time,the amount of bleeding,the hip function,the postoperative infection rate,the dislocation rate and the revision rate in both groups.Results:There were significant differences in the rates of the operating time,the amount of bleeding,the hip function between both groups(P<0.05).There were no significant differences in the rates of the postoperative infection rate,the dislocation rate and the revision rate between both group(P>0.05).Conclusion:Both total hip arthroplasty and hemiarthroplasty are reasonable choices for treatment of displaced fracture of femoral neck in the elderly,but the results of total hip arthroplasty are better than those of hemiarthroplasty.Based on the results of this study,we should select total hip arthroplasty for treatment of the displaced femoral neck fracture(Garden Types Ⅲ-Ⅳ) in the elderly as far as possible unless the patient could not tolerate the surgery or their expected life were less than 5 years.