髋关节置换术和空心加压螺钉内固定术治疗老年股骨颈骨折的效果比较

目的 对比观察全髋关节置换术与空心加压螺钉内固定术两种不同的手术方式对老年股骨颈骨折的疗效,以指导选择老年股骨颈骨折的治疗方案.方法 选择126例老年股骨颈骨折患者,回顾性对比分析患者行全髋关节置换术（A组,n=64）及内固定术（B组,n=62）两种不同治疗方式的手术时间、术中出血量、扶双拐下地时间、住院时间、并发症情况及术后关节功能的变化.结果 A组平均手术时间比B组明显延长（72.8±10.1）min vs（55.7±7.8）min,P＜0.05];A组平均术中出血量显著多于B组（365.5±51.2）mL vs （180.8±25.3） mL,P＜0.01];A组平均扶双拐下地时间显著少于B组（7.5±1.2）d vs（48.7±6.8）d,P＜0.01];A组平均住院时间与B组比较,差异无统计学意义（14.5±2.5） d vs （15.2±2.1）d,P＞0.05].A组并发症出现率明显低于B组（3.13％ vs 19.35％,P＜0.01）.A组Harris功能评分优良率明显高于B组（92.19％ vs 75.81％,P＜0.01）;A组无移位组Harris功能评分优良率与B组比较,差异无统计学意义（90.91％ vs 88.89％,P＞0.05）;A组移位组Harris功能评分优良率显著高于B组（92.85％ vs 60.00％,P＜0.01）.结论 全髋关节置换术适合于髋关节本身有骨关节炎、伴有严重骨质疏松症或有其他老年病不宜长期卧床的股骨颈骨折患者;而内固定术可作为受伤前髋关节活动能力好、骨质量好的或有严重内科合并症不能耐受关节置换的老年股骨颈骨折患者的首选治疗方案.

A comparative study of the effects of total hip replacement and internal fixation surgical treatments on the elderly patients with femoral neck fracture

Objective The paper was to comparatively observe the effects of total hip replacement and internal fixation surgical methods on elderly femoral neck fractures （FNF） in order to determine the appropriate treatment of elderly FNF. Methods 126 cases of elderly patients with FNF, including 64 cases （group A） with the treatment of total hip replacement and and 62 cases （group B） with the treatment of internal fixation, were retrospectively analyzed. The levels of the changes in operative time, blood loss, ambulation time, hospital stay, postoperative complications and functional recovery were evaluated and compared, respectively. Results The mean operative time of group A was significantly longer than that in group B （72.8 ± 10.1） min vs （55.7 ±7.8） min, P 〈 0.05]; The average blood loss of group A was significantly more than group B （365.5±51.2） mL vs （180.8±25.3） mL, P〈0.01]; and the mean ambulation time group A was significantly shorter than that in group B （7.5± 1.2） d vs （48.7±6.8） d, P〈0.01]. Differences between the two groups of change in the average length of hospital stay were not statistically significant. The complication occurrence rate of group A was significantly lower than group B （3.13% vs 19.35%, P〈0.01）. The excellent rate of Harris function scores of group A was significantly higher than group B （92.19 % vs 75.81%, P〈 0.01）; There was not statistical significant difference in the excellent rate of non-shift Harris function scores of group A and group B （90.91% vs 88.89%, P〉 0.05）. However, the excellent rate of displaced Harris function scores of A group was significantly higher than group B （92.85 % vs 60.00 %, P〈 0.01）. Conclusions Total hip replacement have the advantages of short ambulation time, less postoperative complications and good joint function, which is suitable for those elderly femoral neck fracture patients with hip joint os- teoarthritis, severe osteoporosis or other serious geriatric diseases. Internal fixat