内固定和全髋置换治疗老年移位型股骨颈囊内骨折的疗效比较

目的比较内固定和人工全髋关节置换术治疗老年移位型股骨颈囊内骨折的效果。方法自2000年1月～2007年6月,90例老年移位型股骨颈囊内骨折的患者按随机对照试验设计,47例行内固定术,43例采用人工全髋关节置换术,随访24～48个月,平均(28.0±18.0)个月。髋关节功能评价根据Harris评分法进行评分,综合评价指标:包括手术时间、术中失血量、输血量、平均住院日、下床时间、完全负重时间、总的医疗费用、再手术、并发症情况等。结果内固定组平均住院日、下床时间、完全负重时间、医疗费用、再手术和并发症明显高于全髋置换组,髋关节Harris评分、术中失血量及输血量低于全髋置换组,平均手术时间与全髋置换组无明显差别。结论人工全髋关节置换术治疗老年移位型股骨颈囊内骨折优于内固定术。

Comparing the treatment effect of internal fixation and total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients

Objective To compare the curative effect of displaced intracapsular fractures of the femoral neck in elderly patients treated with internal fixation or total hip replacement. Methods From Jan. 2000 to May. 2007, 90 patients with displaced intraeapsular fractures of the femoral neck in elderly patients were categorized according to randomization control trial（ 47 cases underwent internal fixation ;43 cases underwent total hip replacement ）. All pa- tients were followed up for a mean of （ 28.0 ~- 18.0 ） months （ ranging from 24 to 48 months）. The hip function as- sessment was scored according to Harris methods, whereas the synthetic evaluation included surgery time, intraoper- ative blood loss, blood transfusion, mean hospital stay, out-of-bed time, weight bearing time, total medical cost, reop- eration, and complication and so on. Results Compared with the total hip replacement group, the mean hospital stay, out-of-bed time, weight bearing time, total medical cost, reoperation rate and complication rate were higher in the internal fixation group, and Harris score, intraoperative blood loss, blood transfusion were lower in internal fixa- tion group. The mean surgery time showed no significant difference between the two groups. Conclusion The treat- ment effect of total hip replacement on displaced intracapsular fractures of the femoral neck in elderly patients is bet- ter than that of internal fixation.