人工股骨头置换术和全髋关节置换术治疗老年股骨颈骨折的疗效分析

Clinical analysis of total hip replacement and femoral head replacement in treatment of femoral neck fracture in elderly

目的分析老年股骨颈骨折应用人工全髋关节置换术与股骨头置换术的疗效及安全性。方法选取2018年1月—2020年6月河南科技大学第一附属医院收治的股骨颈骨折患者80例,将采用人工股骨头置换术治疗的40例作为对照组,将采用人工全髋关节置换术治疗的40例作为研究组,比较两组疗效及安全性。结果两组住院时间比较,差异无统计学意义(P>0.05),对照组患者的术后引流量和术中出血量均小于研究组,研究组手术时间长于对照组,P<0.05;人工全髋关节置换术治疗的研究组髋关节功能优良率为90.00%,人工股骨头置换术治疗的对照组优良率为87.50%,研究组优于对照组,但组间差异无统计学意义(P>0.05);研究组术后1个月的肿瘤坏死因子-α(TNF-α)水平为(15.26±3.41)pg/mL,白介素-1(IL-1)水平为(3.26±0.81)pg/mL,与对照组比较均明显较低(P<0.05);研究组中2例发生并发症,其中切口感染和下肢静脉血栓各1例,总发生率为5.00%;对照组中有10例出现并发症,其中下肢静脉血栓4例,切口感染3例,髋部疼痛2例,关节脱位1例,对照组并发症发生率明显高于研究组(P<0.05)。结论老年股骨颈骨折治疗中采用股骨头置换术和人工全髋关节置换术均能取得较好的疗效,但人工股骨头置换术给患者造成的创伤小,人工全髋关节置换术炎性反应改善更为明显,并发症更少,具有更好远期疗效,临床可根据患者具体病情合理选择手术方法。

Objective To analyze the clinical effect of total hip replacement and femoral head replacement in the treatment of femoral neck fracture in the elderly.Methods A total of 80 patients with femoral neck fracture admitted to our hospital from January 2018 to January 2020 were selected and divided into two groups using the random number table method,with 40 patients in each group.The control group was treated with artificial femoral head replacement,while the study group was treated with total hip replacement,and the therapeutic effects of the two groups were compared.Results The operation time of the control group was shorter than that of the control group,and the intraoperative blood loss and postoperative drainage volume were less than that of the control group(P<0.05).There was no statistically significant difference between the two groups in terms of length of hospital stay and rate of hip joint functional recovery(P>0.05).The levels of TNF-and IL-1 in the study group were(15.26±3.41)pg/mL and(3.26±0.81)pg/mL one month after surgery,both of which were significantly lower than those in the control group(P<0.05).The complication rate of the study group was 5.00%,lower than that of the control group(25.00%),with statistically significant difference(P<0.05).Conclusion Total hip arthroplasty with femoral head replacement in elderly femoral neck fracture treatment have good curative effect,but the artificial femoral head replacement for the small trauma patients,total hip arthroplasty inflammatory reaction improvement is more apparent,fewer complications,has better long-dated curative effect,clinical choose the surgery methods according to the specific patient.