老年伴有并存症的股骨颈骨折髋关节置换疗效分析

Clinical analysis of the treatment with hip joint replacement for femoral neck fracture of the concomitants in the elderly patients

[目的]评价老年有并存症的股骨颈骨折、髋关节置换及围手术期的治疗等问题。[方法]将1997年6月～2003年12月收治的486例,65岁以上有并存症,GardenⅢ、Ⅳ型股骨颈骨折患者,分别采用全髋关节置换术(THR)和半髋关节置换术(PR)。[结果]486例随访时间18～72个月,平均36.5±6.2个月,两组在并存症等级、手术时间[THR平均(80.5±20.6)min,PR平均(60.2±10.7)min],失血量[THR平均(380.4±150.6)ml,PR平均(230.5±120.2)ml]方面,差异显著(P<0.05)。功能评价按照Harris[1]评分标准,优良率[THR(92.6±1.5)%],PR[(86.2±1.6)%]有显著性差异(P<0.05)。[结论]根据并存症的等级情况,选择全髋或半髋关节置换是治疗伴有并存症的老年股骨颈骨折的较好的方法,有助于安全度过围手术期,恢复功能活动,提高患者生活质量。

Objective： To evaluate the clinical outcomes in the treatment of femoral neck fracture of the concomitants in the elderly patients with hip joint replacement, and to explore the selection of surgical type and the opportunity of operation during perioperation. Method ： A total of 486 patients aged over 65 years with displaced femoral neck fracture （ Garden Ⅲ-Ⅳ） underwent either THR or PR operations. The postoperative follow-up ranged from 18 to 72 months. Result： There was a significant difference（ P〈0.05） in the comparison of the concomitants type; operative time （80.5±20.6min in THR, 60.2±10.7min in PR） ; blood loss in operation （380.4±150.6 ml in THR ,230.5±120.2ml in PR）. According to Harris standards, there was a significant difference （P〈0.05） （92.6±1.5% of satisfactory rate in THR, 80.2±1.6% of satisfactory rate in PR） as well. Conclusion： It is a satisfactory method to treat the concomitants of the femoral neck fracture in the elderly patients by total hip replacement or femoral head replacement, it can avoid the risk during the operative time and recover the function and improve the life quality in the aged patients.