加长型与标准型股骨假体用于高龄股骨颈骨折人工股骨头置换术的对比研究

目的比较标准型与加长型股骨假体在高龄股骨颈骨折患者中的应用效果。方法选择2010年1月~2015年1月大连大学附属中山医院骨科收治的年龄≥80岁股骨颈骨折患者120例,男性66例,女性54例;年龄80~93岁。根据使用的股骨假体不同,分为对照组(62例)和观察组(58例)。对照组选择标准型股骨假体,观察组选择加长型股骨假体,比较两组患者术后并发症发生率及相关指标。结果两组患者术后早期并发症的发生率差异无统计学意义(P=0.914),观察组患者术后晚期并发症明显少于对照组(P=0.000)。依据髋关节假体正位片Delee-Charnley分区法对两组患者进行影像学评估,观察组骨溶解率与松动率均为1.79%,明显低于对照组的14.75%和16.39%(P=0.012,0.007)。术后3、6个月,观察组与对照组Harris评分差异无统计学意义(P0.05);但术后1、2年观察组Harris髋关节功能评分分别为(85.21±2.01)分和(86.45±2.86)分,明显高于对照组的(81.43±1.67)分和(82.45±2.09)分(P=0.000)。结论加长型股骨假体治疗高龄患者股骨颈骨折,具有较好匹配性和生物稳定性,可以有效减少远期并发症发生率,提高术后远期Harris评分,安全可靠,值得临床推广应用。

Comparison of normal and long-type prosthesis for hip replacement in elderly patients with femoral neck fractures

Objective To compare the effect of standard and long-type femoral prosthesis in elderly patients with femoral neck fracture.Methods A total of 120 patients of more than or equal to 80 years old with femoral neck fracture were selected in our hospital from Jan.2010 to Jan.2015. There were 66 males and 54 females,with age of 80-93 years old.They were divided into the control group (n=62) and the observation group (n=58) according to different femoral prosthesis.The control group was treated with standard femoral prosthesis,and the observation group was treated with long-type femoral prosthesis.The incidence of postoperative complications and related indicators were compared between the two groups.Results There was no significant difference in the incidence of early postoperative complications between the two groups (P=0.914).The postoperative complications in the observation group were significantly less than those in the control group (P=0.000).On the basis of Delee-Charnley partition method for radiographic assessment of patients in the two groups,the rates of osteolysis and loosening were both 1.79％ in the observation group,significantly lower than those of the control group of 14.75％ and 16.39％(P=0.012,0.007).Three months and 6 months after surgery,no statistical significance in Harris score between the observation group and the control group was found;but 1 year and 2 years after surgery,Harris hip score in the observation group was (85.21±2.01) and (86.45±2.86),significantly higher than those of the control group (81.43±1.67) and (82.45±2.09),P=0.000].Conclusion The long-type femoral prosthesis for the treatment of elderly patients with femoral neck fracture has good biological stability,can effectively reduce the incidence of complications and improve the long-term postoperative Harris score.It is safe and reliable,and is worthy of clinical application.