内固定与关节置换治疗老年移位股骨颈骨折的前瞻性比较研究

Displaced femoral neck fractures in patients aged from 60 to 75 years old： internal fixation vs. arthroplasty

目的前瞻性研究比较老年有移位的股骨颈骨折经内固定和关节置换的预后情况。方法1994年1月-2000年12月，对92例因意外导致新鲜有移位的老年股骨颈骨折（GardenⅢ、Ⅳ型）患者随机行内固定或关节置换治疗，内固定组48例，关节置换组36例。随访时比较两种治疗方法的并发症、髋关节功能、日常生活能力和SF-36生活质量指数。结果5例失访，3例在随访中死亡，84例获得5-11年（平均6．2年）随访。内固定组（36例）和关节置换组（36例）并发症发生率分别为25．0％和19．4％。两组患者都拥有中等以上的髋关节功能及日常生活能力。生活质量指数都处于相对自理的水平，关节置换组略高于内固定组。结论老年有移位的股骨颈骨折分别经内固定和关节置换治疗的虽然均有较高的术后并发症发生率，但关节置换组在生活质量上略高于内固定组，因而关节置换治疗应为首选措施。

Objective To compare internal fixation with arthroplasty in the treatment of displaced femoral neck fractures in patients aged from 60 to 75 years old. Methods Ninety-two patients, whose ages ranged from 60 to 75 years, with an acute displaced femoral neck fracture （Garden types Ⅲ ＆ Ⅳ） caused by accidental falls were included in the research. The included patients were treated randomly with internal fixation or arthroplasty. Main outcome measurements included complication, functional outcome （Harris Hip Score）, activity of daily living, and SF-36 Quality of Life. Results Eighty-four patients were followed up for 5 to 11 （average, 6. 2） years, 5 got lost and 3 died. The complication rates for internal fixation group and arthroplasty group were 25.0% and 19. 4%, respectively. Both groups had more than moderate functional outcomes and activities of daily living. SF-36 Quality of Life scores were higher with arthroplasty than with internal fixation, although beth groups scored above average. Conclusions Although the complication rate of displaced femoral neck fractures in patients aged from 60 to 75 years old is high in spite of treatment methods, the postoperative quality of life seems to be better in those managed with arthroplasty than in those with internal fixation. Thus we recommend arthroplasty to be the treatment method of choice.