双极人工股骨头置换术与全髋关节置换术治疗老年股骨颈骨折疗效比较

目的比较双极人工股骨头置换术（bipolar femoral head replacement,BFHR）与全髋关节置换术（total hipreplacement,THR）治疗老年人股骨颈骨折的疗效。方法对2004年3月至2010年2月我院收治的老年股骨颈骨折患者进行随访研究,共获得74例有完整随访资料的病例。根据手术方法不同分为BFHR组和THR组,BFHR组42例,男7例,女35例,平均年龄77.3岁。THR组32例,男9例,女23例,平均年龄74.8岁。比较两组患者的手术时间、术中失血量、术中输血量、术后引流量、住院费用、住院时间及术后髋关节功能恢复程度。结果两组患者经过1～6.5年（平均3.2年）随访,BFHR组和THR组在住院时间、术后引流量及术后1年髋关节功能方面比较,差异无统计学意义（P〉0.05）;而在手术时间、术中输血量、术中失血量、住院费用、术后3年及5年髋关节功能方面比较,差异有统计学意义（P〈0.05）。结论老年股骨颈骨折行THR后关节功能恢复较好,远期并发症较低,是老年人股骨颈骨折的首选治疗方法;BFHR具有手术时间短、创伤小、出血少及住院费用低等优点,适合于少数身体状况差、伤前活动量小、伴有较多基础病、或受伤前伤肢已有功能障碍的高龄患者。

BipolarFemoral Head Replacement Versus Total Hip Replacement in Treatment of Elderly Patients with Femoral Neck Fracture

Objective To investigate the clinical outcomes of elderly patients with femoral neck fracture who were treated by BFHR and THR. Methods We randomized 74 patients with femoral neck fracture to surgical treatment with either BFHR or THR and followed them post-operatively from March 2004 to February 2010. There were 42 cas- es in the BFHR group and 32 in the THR group. We compared the two groups from operative time,intra-operative blood transfusion ,intra operative blood loses ,postoperative drainage ,hospitalization period ,cost of hospitalization and postoperative recovery of hip function. Results Two groups of patients are interviewed randomly from 1 year to 6.5 years, 3.2 years on average. There was no significant difference between BFHR group with THR group in hospitaliza- tion period, postoperative drainage and 1 year postoperative recovery of hip function （P~ 0.05）. However, operative time,intra-operative blood loses,intra-operative blood transfusion, 3 years and 5 years postoperative recovery of hip function between the two groups showed significant difference （P~0. 05）. Conclusion Total hip replacement has higher recovery rate of hip function ,less long-term postoperative complications ,and is the preferred method of artifi- cial hip replacement. Bipolar femoral head replacement is a more suitable method for elderly patients who are in worse health conditions ,with basic diseases ,with smaller exercise-load ,or with hip dysfunction before injury ,because it has advantages in little trauma,less intra-operative blood loses,less operative time,less cost of hospitalization etc.