关节置换术与内固定术处理老年人移位性股骨颈骨折的疗效比较

目的比较关节置换与内固定治疗老年移位性股骨颈骨折的临床疗效。方法将重庆市九龙坡区第一中医院2001年5月至2005年4月收治的84例老年(≥60岁)移位性股骨颈骨折病例进行回顾性分析。其中关节置换组39例,内固定组45例。分别比较两组患者术后2年病死率、手术相关并发症的发生率、再手术率及髋关节功能。结果关节置换组与内固定组患者术后2年病死率分别为10.3%(4/39)与11.1%(5/45),两组间比较无明显统计学差别(P>0.05)。内固定组术后手术相关并发症发生率为42.2%(19/45),需再次手术行髋关节置换术13例,再手术率为28.9%;关节置换组术后手术相关并发生发生率为15.4%(6/39),再手术率为15.4%(6/39),关节置换组的术后并发症及再手术率明显低于内固定组(P<0.05)。术后关节置换组髋关节功能优良率为79.5%(31/39),优于内固定组(55.6%,25/45)。结论区别于内固定术组,关节置换术组可以减少术后并发症和再手术率的发生,具有更好的术后髋关节功能,并且不会增加术后病死率。关节置换术应作为老年移位性股骨颈骨折的首选治疗。

Therapeutic Comparison between Arthroplasty and Internal Fixation for Displaced Femoral Neck in Elderly

Objective To compare the clinical effects of arthroplasty and internal fixation in treatment of the displaced femoral neck fracture in elderly. Methods Eighty-four patients （≥60 years old） displaced femoral neck fracture who underwent either arthroplasty or internal fixation from May 2001 to April 2005 were analyzed retrospectively, of which 39 cases were with arthroplasty and 45 with internal fixation. We assessed the clinical results of internal fixation and arthroplasty with regard to mortality, re-operations, major method-related complications and hip joint function in the treatment of displaced femoral neck fracture. Results The mortality at two years postoperatively of arthroplasty and internal fixation were 10.3% （4/39） and 11.1% （5/45）, respectively. There was no significant difference between the two groups（P〉0.05）. In the internal fixation group, the rate of major method-related complication was 42.2% （19/45）, and required re-operations of hip arthroplasty were 13 cases, re-operation rate was 28.9%.In the arthroplasty group, the rate of major method-related complication was 15.4%（6/39）, and re-operation rate was 15.4%（6/39）.The rate of major method-related complication and re-operation in the arthroplasty group was significantly lower than that of internal fixation group （P〈0.05）. Excellence rate of the hip joint function in the arthrnplasty group was 79.5% （31/39）, and it was better than that of internal fixation group （55.6%, 25/45）. Conclusion Compared with internal fixation, arthroplasty can not only reduce the surgical revision, but also decrease the incidence of complications, and do not increase mortality. In this study, it shows that there is an evidence base to support arthroplasty as a primary treatment for displaced femoral neck fractures in the elderly.