人工髋关节置换术治疗高龄股骨颈骨折的临床研究

Clinical Research on Hip Arthroplasty in Treatment of Femoral Neck Fracture in Elderly

目的对比全髋关节置换(THA)与双动股骨头置换(BFHR)的临床应用结果,并分析高龄股骨颈骨折患者实施人工髋关节置换术的要点。方法高龄股骨颈骨折行髋关节置换72例,分为THA组42例,BFHR组30例。记录手术时间、术中术后出血量、开始下床活动的时间、Harris评分,以及术后并发症。结果随访11～25个月。BFHR组手术时间小于THA组(P<0.05);术中出血量BFHR组少(P<0.05);BFHR组的患者在术后主动直腿抬高角度大于THA组,术后开始下床活动时间明显缩短,术后1周髋关节Harris评分高,但术后6周、3个月、6个月的评分两组无显著性差异;BFHR组术后早期并发症发生率低,但远期髋关节疼痛的发生率高于THA组。结论高龄股骨颈骨折是行人工髋关节置换的适应证;双动股骨头置换术的术后近期恢复较好,但远期效果不及全髋关节置换术。

Objective To investigate and compare the feasibility and clinical outcome of the bipolar femoral head replacement （BFHR） and total hip arthroplasty （THA） in treatment of femoral neck fracture in elderly. Methods Seventy- two patients with hip arthroplasty were divided into two groups randomly. In THA group, 42 patients were operated with lateral approach. In BFHR group, 30 patients were operated with lateral approach. The time of operation, the intra - and post - operative blood loss, and the time to leave bed were recorded. Harris score in 1 week, 6 weeks, 3 months, and 6 months postoperatively were assessed. Results The patients were followed up from 11 to 25 months. The time of operation in group of BFHR was 65 ±9 （48-71） min, and in group of THA was 83 ± 27 （61-180） min, P 〈 0.05; the post - operative blood loss was 200 ± 57 and 410 ± 97 respectively, P〈 0.05. The patients in the BFHR group could usually perform the straight leg raises actively on the fourth postoperative day. The earliest time to leave the bed was shorter in the BFHR group than in the THA group. The Harris score of hip joint at 1 week post - operatively was higher in the BFHR group than in the THA group, but at 6 weeks, 3 months and 6 months, the score of the two groups had no significant differences. Early complications occurred less in the BFHR group than in the THA group, but the patients suffered more long- term hip pain in BFHR group than in the THA group. Conclusion The femoral head fracture in the elderly is the indication for the hip arthroplasty. The bipolar femoral head replacement has the better short- term results, but the worse long- term outcome than total.hip arthroplasty.