股骨颈骨折合并帕金森患者行股骨头置换术疗效比较

目的比较不同程度帕金森病(PD)患者发生股骨颈骨折并行双极人工股骨头置换术后的治疗效果。 方法回顾近年来在重庆市开州区中医院骨科行双极人工股骨头置换术的合并了PD的股骨颈骨折患者。纳入单侧股骨颈骨折、行双极人工股骨头置换术患者；排除PD发病前已有姿势不稳、步态异常，股骨柄采用骨水泥型假体的患者。对手术时间、术中出血量、术后引流量、住院时间、术后1年随访髋关节Harris评分行Mann-Whitney U秩和检验。 结果共纳入Hoehn-Yahr 3级患者8例(61.5%)，含7例男性、1例女性，Hoehn-Yahr 4级患者5例(38.5%)，均为男性。两组患者的年龄(Z＝-0.665)、术中出血量(Z＝-0.401)、术后引流量(Z＝-0.590)、住院时间(Z＝-0.301)基本一致(P>0.05)。Hoehn-Yahr 3级患者的手术时间更短(Z＝-2.143，P<0.05)。患者术后髋关节Harris评分较术前的变化：Hoehn-Yahr 3级组为15～21，Hoehn-Yahr 4级组为18～26，Hoehn-Yahr 3级的患者术后Harris髋关节评分改变更少(Z＝-2.372，P<0.05)。 结论对于PD Hoehn-Yahr分期3级、4级的股骨颈骨折行双极人工股骨头置换术患者，Hoehn-Yahr 3级患者的手术时间更短、且术后髋关节功能减退更少。

Effect comparison of femoral head replacement for femoral neck fracture in Parkinson's patients

Objective To compare the effects of patients with different degrees of Parkinson's disease(PD)who had femoral neck fracture and bipolar femoral head replacement.Methods A review of patients with femoral neck fracture combined with PD who underwent bipolar femoral head replacement in the orthopedics department of Kaizhou District Traditional Chinese Medicine Hospital in recent years.Inclusion creteria:unilateral femoral neck fracture,bipolar femoral head replacement.Exclusion creteria:the patients with posture instability and abnormal gait before the PD onset,or the femoral stem prosthesis was cemented.Mann-Whitney U test was performed on the operation time,intraoperative blood loss,postoperative drainage,hospitalization time,and one-year follow-up Harris score of the hip after the operation.Results Eight cases(61.5%)of Hoehn-Yahr grade three were enrolled,including seven males and one female.Five cases(38.5%)of Hoehn-Yahr grade four were also enrolled,all of whom were male.The age(Z=-0.665),intraoperative blood loss(Z=-0.401),postoperative drainage(Z=-0.590),and length of hospital stay(Z=-0.301)of the two groups were basically the same(P>0.05).The operation time of Hoehn-Yahr grade three group was shorter(Z=-2.143,P<0.05).The changes in the Harris score after the surgery compared with those before surgery were as follows:15-21 of Hoehn-Yahr grade three group,and 18-26 of Hoehn-Yahr grade four group.The patients of Hoehn-Yahr grade three had less change in Harris hip score after the surgery(Z=-2.372,P<0.05).Conclusion For the patients with femoral neck fractures in PD Hoehn-Yahr grade three and four undergoing bipolar femoral head replacement,the patients of Hoehn-Yahr grade three may have shorter operation time and less postoperative hip function decline.