全髋关节置换与内固定治疗股骨颈骨折临床疗效分析

Clinical Study on the Treatment of Femoral Neck Fracture by Total Hip Replacement and Internal Fixation

目的对内固定术和全髋关节置换术治疗不同年龄段的新鲜股骨颈骨折进行临床回顾性对比研究。方法31例行全髋关节置换病例为A组,35例行内固定治疗病例为B组。再将两组患者分别以65岁为界限分为两个亚组,65及65岁以上为A1(22例)和B1(6例),65岁以下者为A2(9例)和B2(29例)。对其手术及术后功能恢复情况进行跟踪随访,术后平均随访时间3.8年。随访内容包括:受伤至手术时间、并发症、扶双拐下地活动时间及功能评价。进行临床及影像学分析,并同国内外其他作者的报告进行对比。结果66例患者术后Harris评分优良率占59%。31例全髋关节置换术后优良率占71%(22例),其中27例无病废患者平均Harris评分90.4分;35例内固定术后优良率49%(17例),其中20例无病废患者平均Harris评分91.6分。15例严重病废患者中股骨头坏死7例(占20%),骨折不愈合6例(占17.1%),因其他原因导致失败2例(5.7%)。其中股骨头坏死患者发生在65岁以下组(24～58岁),占B2组21.7%,而B1组仅1例发生股骨头坏死;不愈合率B1组为33.3%(2例)、B2组为13.8%(4例)。结论①全髋关节置换是一种有效的治疗方法,但要严格掌握假体置换的适应证,且应规范手术操作,不宜简单仅根据患者的骨折类型和年龄来划分,对于65岁以上股骨颈骨折患者,同样可以首选中空拉力螺钉内固定。②内固定术应遵循:急诊手术(8h以内)、解剖复位、坚强固定、尽量保护血运的原则进行。

Objective To investigate the clinical therapeutic effect of total hip arthroplasty （THA） and internal fixation （IF） on the fractures of femoral neck. Methods Thity - one cases of femoral neck fracture treated by THA were classified as group A, 35 cases treated by IF were classified as group B. They were further divided into follow groups： A1, 22 cases, their age were 65 or over 65 years; A2, 9 cases, below 65 years; B1, 6 cases, 65 or over 65 years; B2, 29 cases, below 65 years. They were treated between 1990 and 2002. The follow - up time was averaged 3.8 years （1.0-12.0 years）. Results The curative effect of THA was better than that of IF. The complications and secondary surgery rate were relatively higher in IF group. There were 16.7% and 21.7% cases of femoral head necrosis in group B1 and group 82, respectively. The non- union rate in group B1 and group 82 was 33.3% and 13.8% respectively. Conclusion Total hip replacement is suitable for the older patients with the femoral neck fracture, but the indication of THA should be grasped. IF can be applied to the patients over 65 years old sometimes. The principle of emergency operation, anatomical reduction, rigid fixation and undisturbed blood supply must be followed.