半髋关节置换术治疗老年股骨颈骨折的疗效分析

Analysis on clinical results of hemiarthroplasty for femoral neck fractures in the elderly

目的总结半髋关节置换术治疗老年股骨颈骨折的疗效。方法自1998年1月至2008年1月，采用半髋关节置换术治疗老年股骨颈骨折84例，其中男24例，女60例；平均年龄80岁（75～97岁）。手术分别采用单极和双极股骨头假体置换治疗40例和44例，其中选用现代股骨柄行生物学固定40例，选用老式股骨柄分别行骨水泥和生物学固定29例和15例。结果本组中50例获平均5年（1—10年）随访。X线片显示，髋臼软骨总体磨损率为50％（25／50），其中单极头和双极头组的磨损率分别为83％（20／24）和19％（5／26）。总体肯定松动率为40％（20／50），其中老式柄骨水泥固定6例，老式柄生物学固定14例。总体翻修率为24％（12／50），其中单极头和双极头组的翻修率分别为37．5％（9／24）和12％（3／26）。统计显示双极头组的髋臼软骨磨损和翻修率显著低于单极头组（P〈0．01），老式柄骨水泥固定组的松动率显著低于老式柄生物学固定组（P〈0．01），但与现代柄的生物学固定组比较，差异无统计学意义（P〉0．05）。结论双极头假体置换术的疗效优于单极头，老式柄骨水泥固定优于老式柄生物学固定，但与现代柄生物学固定的疗效相似。

Objective To summarize effect of hemiarthroplasty in treatment of femoral neck fractures in the elderly. Methods From January 1998 to January 2008, hemiarthroplasties were performed in 84 patients with femoral neck fractures, including 24 males and 60 females, at age range of 75-97 years （mean 80 years）. Of all, 40 patients were treated with unipolar hemiarthroplasty and 44 with bipolar hemiarthroplasty. In the meantime, 29 patients were treated with cement fixation and 15 with biological fixation with old femoral stems, and 40 with biological fixation with contemporary femoral stem. Results There were 50 patients （24 in unipolar and 26 in bipolar group） were followed up for average five years （1-10 years）. X-ray showed total acetabular erosion rate of 50% （25/50）, with 83% （20/24） in unipolar group and 19% （5/26） in bipolar group. Total definite loosening rate was 40% （20/50）, which was distributed in six patients treated with cement fixation and 14 with biological fixation. Total revision rate was 24% （ 12/50）, with 37.5% （9/24） in unipolar group and 12% （3/26） in bipolar group. Sta- tistical analysis showed that acetabular erosion rate and revision rate in bipolar group were lower than those in unipolar group （P 〈 0.01 ）. Definite loosening rate in cement fixation group was significantly lower than biological fixation group, with no statistical difference compared with biological fixation of contemporary stem （P 〉 0.05）. Conclusions Bipolar replacement is significantly better than unipolar replacement for femoral neck fracture in the elderly. Cement fixation with old femoral stem is significantly better than biological fixation with old femoral stem, which is similar to biological fixation with contemporary femoral stem.