全髋关节置换治疗老年股骨颈骨折及其并发症分析

Analysis of Total Hip Replacement on Femoral Neck Fracture in Elder Patients and Its Complications

目的观察全髋关节置换治疗老年股骨颈骨折疗效,并探讨其并发症的防治。方法选取78例股骨颈骨折行全髋关节置换治疗的老年患者,观察疗效,术前术后Harris评分及并发症情况。结果78例平均住院22.4 d(16～40 d)后均顺利出院,髋关节评分由术前的(28.3±5.2)分提高到术后出院时的(81.4±4.8)分,差异有统计学意义(P<0.05);术后6个月时Harris评分提高至(87.6±3.4)分,较出院时差异有统计学意义(P<0.05)。围手术期发生高血压8例,心律失常6例,血压下降7例,置换关节脱位3例,伤口感染6例,肺部出现并发症5例,泌尿系感染5例,深静脉炎4例,下肢深静脉栓塞3例,应激性溃疡出血2例,均经积极处理后治愈。结论老年股骨颈骨折术前应积极治疗相关内科合并症,把握时机,及时施行全髋关节置换术。

Objective To observe the therapeutic effects of the total hip replacement on femoral neck fracture and explore the prevention and cure for its complications. Methods Seventy - eight elder patients with femoral neck fracture treated with total hip replacement were selected. Their therapeutic efficacy, preoperative and postoperative Harris scores and the complications were also analyzed. Results All patients were discharged successfully after an average hospitalization time of 22.4 days （ranged from 16 to 40 days ） after the operation. The Harris scores of the patients at the time discharging increased from 28.3 ± 5.2 （preoperative score） to 81.4 ± 4.8 （P〈 0.05）, and 87.6±3.4 after 6 months （P 〈 0.05, compared to the discharging Harris score）. The complications were as follows： hypertension in 8 patients, arrhythmia in 6 patients, hypopiesia in 7 patients, replacement joint dislocation in 3 patients, wound infection in 6 patients, lung complications in 5 patients, urinary system infection in 5 patients, deep vein phlebitis in 4 patients, deep veins thrombus of lower limb in 3 patients and stress ulcer in 2 patients. All the complications were cured by active treatment. Conclusion The total hip replacement should be promptly performed on femoral neck fracture of elder patients after other diseases were actively treated.