全髋关节置换术与内固定术治疗糖尿病股骨颈骨折患者的疗效对比分析

目的分析全髋关节置换术与内固定术治疗糖尿病股骨颈骨折患者的疗效。方法回顾性分析2013年1月—2015年12月在复旦大学附属华东医院骨科治疗的60例二型糖尿病股骨颈骨折患者,其中男性30例,女性30例;年龄43~62岁,平均51.1岁;致伤原因均为高处坠落伤。根据手术方案不同分为研究组(n=30)和对照组(n=30)。研究组患者采用全髋关节置换术进行治疗,对照组患者采用空心钉内固定治疗。观察并记录两组患者的手术时间、出血量、输血量、住院时间、髋关节功能有效率、术后并发症发生率及X线片诊断结果,并对结果进行分析比较。结果术后随访时间1年。研究组患者的手术时间、出血量、输血量、住院时间分别为(99.3±17.9)min、(334.6±24.8)mL、(298.4±30.4)mL、(12.2±3.8)d,明显高于对照组(86.3±17.8)min、(197.2±23.5)mL、(194.5±31.0)mL、(9.9±2.2)d],差异有统计学意义(P0.05);研究组患者的术后活动时间(5.3±2.3)d]明显短于对照组(9.7±5.2)d],差异有统计学意义(P0.05);治疗后,研究组患者的髋关节功能有效率(93.4%)明显高于对照组(73.3%),差异有统计学意义(χ~2=4.3200,P0.04);研究组患者出现异位骨化病2例,假体远端骨折3例;对照组出现股骨头塌陷1例,股骨不愈合3例,股骨头坏死2例,异位骨化病1例;研究组患者术后并发症包括深静脉血栓1例,尿路感染1例,对照组包括深静脉血栓2例,尿路感染1例,肺炎1例,两组比较差异无统计学意义(P0.05);研究组患者中死亡2例,病死率为6.6%,对照组患者中死亡1例,病死率为3.3%,两组比较差异无统计学意义(P0.05)。结论内固定法治疗操作简单,出血少,住院时间短;全髋关节置换治疗术后活动时间较早,治疗优良率高,临床应根据患者的具体情况选择合适的手术方式。

Comparison of curative effect of total hip arthroplasty and internal fixation in the treatment of diabetic femoral neck fracture

Objective To analyze the curative effect of total hip arthroplasty and internal fixation in the treatment of diabetic femoral neck fracture .Methods Totally 60 cases (30 males and 30 females with an average age of 51.1 (43-62 years) with diabetic femoral neck fracture from Jan .2013 to Dec.2015 in our hospital were di-vided into the study group (30 cases) and the control group (30 cases) according to different treatment methods . All were injured from high falling .The study group was given total hip arthroplasty ,and the control group was given hollow screw internal fixation.Operation time,blood loss,blood transfusion volume,length of stay,effective rate of hip function,incidence of postoperative complications ,and diagnostic radiographs of the two groups were observed and recorded.Results Patients were followed up for 1 year.The time of operation,blood loss,blood transfusion and length of stay in the study group were significantly higher than the control group ((99.3 ±17.9)min vs.(86.3 ±17.8)min,(334.6 ±24.8) mL vs.(197.2 ±23.5) mL,(298.4 ±30.4) mL vs.(194.5 ±31.0) mL,(12.2 ± 3.8)d vs.(9.9 ±2.2) d,P<0.05).The postoperative training time in the study group was significantly shorter than that of the control group ((5.3 ±2.3)d vs.(9.7 ±5.2)d,P<0.05).After treatment,the efficiency rate of hip function in the study group was significantly higher than that of the control group ,and the difference was statisti-cally significant (93.4%vs.73.3%,χ2 =4.3200,P<0.04).There were 2 cases of heterotopic ossification and 3 cases of distal prosthesis fracture in the study group ,and 1 case of collapse of the femoral head ,3 cases of femoral nonunion,2 cases of femoral head necrosis and 1 case of heterotopic ossification in the control group .There was 1 case of deep venous thrombosis and 1 case of urinary tract infection in the study group ,and there were 2 cases of deep venous thrombosis ,1 case of urinary tract infection and 1 case of pneumonia in the control group .The differ-ence of the incidence of complications between the study group and the control group was not statistically significant (P>0.05).The death rate of the study group was 6.6%(2/30),and the difference was not statistically significant compared with the control group ( 3.3%( 1/30 ) , P>0.05 ) . Conclusion Internal fixation treatment is simple with less bleeding and shorter hospital stay .Total hip replacement treatment has earlier postoperative activities and higher excellent rate .The clinical treatment should be based on the specific circumstances of patients to choose ap -propriate surgical approach .