全髋关节与双极股骨头半髋置换术治疗高龄股骨颈骨折的疗效分析

Clinical results of THA and BHA for the femoral neck fracture in the elderly

目的:回顾性分析全髋关节置换(total hip arthroplasty,THA)与双极股骨头半髋关节置换(Bipolar hip arthroplasty,BHA)治疗70岁以上股骨颈骨折关节功能恢复状况,探讨适合老年股骨颈骨折的最佳手术方法。方法:2005-02～2008-02我院收治的70岁以上股骨颈骨折实行髋关节置换78例78髋。按照手术方式分为THA组和BHA组。其中THA组42例,BHA组36例。全部病例平均随访25个月,从关节功能、Harris评分、住院时间、住院费用、手术时间、术中出血量、不良反应等方面进行比较和随访。结果:THA组术后Harris评分中明显高于BHA组,两组比较差异有显著性意义(P<0.05)。在住院时间与住院费用的比较差异无显著性意义(P>0.05)。结论:THA可以作为治疗老年股骨颈骨折的首选方法,以便获得更好的功能及避免翻修,而对于少数身体条件较差,运动量较小的高龄患者,可考虑选择BHA置换,重建髋关节功能。

Objective： To investigate the best operation mothed for the femoral neck fracture in the elderly, This study was de- signed to explore functional recovery of joints in patients over 70 years with femoral neck fracture by THA and BHA. Methods： 78 pa- tients with femoral neck fracture over 70 years were enrolled from our hospital from February 2005 to February 2008. There were 42 ca- ses receiving THA and 36 cases receiving BHA. The mean time of follow - ups for all patients was 25 months. The difference was compared in joint function, Harris scoring, time of hospitalization, cost of hospitalization , time of operation, blood loss, adverse effect. Results： The Harris scoring of THA is much higher than that of BHA. There were significant differences in these two groups （P 〈 0. 05）. There was no significant difference between two groups in the comparison of time and cost of hospitalization P 〉 0. 05）. Conclusion： We advise that THA Can be the primary method in the treatment of the displaced femoral neck of the old patients because they could help get better function and avoid complications like reoperation and so on. While for the patients with poor health and less movement we advise BP as the primary treatment method.