不同手术方式治疗老年移位性股骨颈骨折术后疗效分析

Comparative study of the results of different operations in treating displaced fracture of the femoral neck in the elderly

目的探讨内固定、人工股骨头置换和全髋置换在治疗老年人移位性股骨颈骨折中的价值。方法对1998-2003年收治的89例65岁以上移位性股骨颈骨折患者进行了随访研究,比较闭合复位内固定、人工股骨头置换和全髋置换术在手术时间、出血量、住院时间、术后1年和2年的功能评价、并发症以及二次手术率方面的差异。结果闭合复位内固定组的手术时间、失血量、住院时间均为最低(P<0.05),但卧床时间最长,并发症和手术翻修率最高,术后2年随访功能最差。全髋置换术卧床时间短,并发症和手术翻修率低,术后髋关节功能最好,但手术创伤较大,对患者身体一般状况要求较高。人工股骨头置换的手术创伤比全髋置换稍小,但并发症发生率、手术翻修率较高,术后功能比全髋置换差。结论全髋置换治疗老年移位性股骨颈骨折,特别是活动能力要求较高、期望寿命较长和身体一般状况好的老年患者,效果较好,值得推广。

Objective To explore the value of different surgieal methods in the treatment of the displaced femoral neck fracture of the elderly. Methods An follow up study was done on 89 cases older than 65 years who were treated with internal fixation, femoral head arthroplasty and total hip joint replacement between 1998 and 2003 to compare the difference upon operation time, blood loss, duration of hospitalization, joint function evaluation one and two years after operation, complications and reversion rate, Results The internal fixation group had the shortest operation time and hospitalization and the least blood loss but the longest immobilization time, highest eomplieation rate and reversion rate as well as the worst joint function, While the total hip joint replacement group had the least immobilization time, the lowest complication rate anti reversion rate, hest joint function but required better health condition. The femoral head arthroplasty group had the least operation injury but had relative higher reversion rate and worse joint function compared to the total hip joint replacement group, Conclusion Total hip joint replacement is suitable for the displaced femoral neck fractures of the elderly, especially those who are active have relative longer life expectantly and good general condition.