三种术式治疗老年股骨颈骨折的疗效比较

目的 通过比较内固定、人工股骨头置换(FHA)及全髋关节置换(THR)治疗老年股骨颈骨折的疗效,探讨老年股骨颈骨折的术式选择. 方法在1999年1月至2007年8月所收治的老年股骨颈骨折患者中,选择年龄、骨折类型、受伤时间及全身情况相似而治疗方式不同的三组共182例患者,其中内固定组42例,Garden分型:Ⅰ型2例,Ⅱ型8例,Ⅲ型17例,Ⅳ型15例;FHA组64例,Garden分型:Ⅱ型16例,Ⅲ型34例,Ⅳ型14例;THR组76例,Garden分型:Ⅱ型19例,Ⅲ型37例,Ⅳ型20例.对三组患者的手术时间、术中出血量、住院时间、扶双拐下地时间、术后并发症、再手术率及关节功能优良率等进行统计学比较. 结果 182例患者术后获25～65个月(平均38个月)随访.内固定组手术时间最短、术中出血量最少,FHA组次之,THR组手术时间最长、术中出血量最多,三组之间比较差异均有统计学意义(P<0.05).住院时间三组之间差异无统计学意义(P>0.05).与内固定组比较,FHA组与THR组扶双拐下地时间较短分别为(7.0±0.8)d,(8.0±0.7)d]、术后并发症发生率较低(10.9%,10.5%)、再手术率较低(7.8%,5.3%)、关节功能优良率较高(85.9%,89.5%),差异均有统计学意义(P<0.05),而FHA组与THR组之间比较差异无统计学意义(P>0.05). 结论对于老年股骨颈骨折患者,FHA和THR具有扶双拐下地时间短、术后并发症少、再手术率低及关节功能恢复好等优点,适合于年龄>65岁的Garden Ⅲ、Ⅳ型股骨颈骨折患者;而内固定术具有手术时间短、术中出血少的优点,可作为年龄>60岁的Garden Ⅰ、Ⅱ型股骨颈骨折患者的治疗首选.

Comparison of three different procedures in the treatment of senile femoral neck fracture

Objective To compare internal fixation and arthroplasty in curative effects for the femoral neck fractures in the aged population. Methods All the 182 old patients with femoral neck fracture who had been treated from January 1999 to August 2007 in our department were reviewed. Of them, 42 cases received internal fixation (Group A), 64 femoral head arthroplasty (Group B) and 76 total hip joint replacement (Group C) . The 3 groups were similar in age, fracture classification and preoperative health condition. Their average follow-up was 38 (25 to 65) months. Comparisons were made between the 3 groups in hospitalization, operating duration, intraoperative bleeding, ambulation time, postoperative complications, secondary surgery, and functional recovery. Results Group A had less operating duration and blood loss, a healing rate of 90.5% (38/42), a rate of avascular femoral head necrosis of 23.8% (10/42), and a re-operation rate of 26. 2% (11/42). In Groups B and C, the re-operation rate was 7.8% (5 cases) and 5.3% (4 cases) respectively. The good-to-excellent rates of functional recovery were 85.9% (55/64), 89.5% (68/76) and 61.9% (26/42) respectively in Groups B, C, and A. In operating duration, blood loss, ambulation time, complications, secondary surgery and functional recovery, there was a significant difference (P<0.05) between internal fixation and arthroplasty, but there was no significant difference in hospitalization (P>0.05). Conclusions In treatment of femoral neck fracture of Garden Ⅰ and Ⅱ in patients older than 60 years, internal fixation may be the first choice, and arthroplasty may be suitable for patients older than 65 years or those with fractures of Garden Ⅲ and Ⅳ.