空心钉内固定与人工关节置换术治疗老年股骨颈骨折疗效比较

Therapeutic comparasion between internal fixation with cannulated screws and arthroplasty for femoral neck fracture in elderly patients

目的对比观察空心钉内固定与人工关节置换术治疗老年股骨颈骨折患者的临床疗效。方法回顾性分析2003年1月～2006年12月收治的60岁以上股骨颈骨折患者100例,其中空心钉内固定组36例,人工关节组64例。两组的年龄、术前全身状况、骨折分型相仿。平均随访时间38.5个月(24～66个月)。应用Harris评分标准进行结果评价。结果空心钉内固定组手术时间短、失血量少,骨折愈合率91.7%(33/36),股骨头坏死率27.8%(10/36),需再次手术行髋关节置换术6例,再手术率为16.7%。人工关节组卧床时间短,但对患者身体一般状况要求高,需翻修手术的9例,再手术率为14.1%。结论两种术式均能恢复老年人生活质量,GardenⅠ、Ⅱ、Ⅲ型的70岁以下老年性股骨颈骨折患者,在复位优良的前提下可先予坚强的内固定治疗,一期髋关节置换术适合于高龄及移位严重的患者。

Objective To observe and compare the clinical effects of internal fixation with cannulated screws and arthroplasty for femoral neck fracture in elderly patients. Methods One hundred patients（over 60 years old） with femoral neck fractures who underwent either internal fixation or arthroplasty from January 2003 to December 2006 were analyzed retrospectively, of which 36 cases were with internal fixation and 64 with arthroplasty. Two groups were similar in age, preoperative health condition and fracture classification. Average follow-up was 38.5 months （range from 24 to 66 months）. Evaluting the function of hip with Harris system. Results The internal fixation group had the shorter operation time and the less blood loss. Healing rate of femoral neck fractures was 91.7%（33/36）, avascular necrosis rate of femoral head 27.8%（10/36） and re-operation rate 16.7% （6/36）. The arthroplasty group had the less immobilization time, but required better health condition. The re-operation rate ofarthroplasty was 14.1% （9 cases）. Conclusion Both internal fixation and arthroplasty can revive the life quality of the elderly. When treating femoral neck fracture of Garden Ⅰ, Ⅱ or Ⅲ in the elderly （〈70 years old）, internal fixation should be the fn＇st choice, and arthroplasty is suitable for the patients older than 70 years or those with the severely displaced fractures.