不同手术方法治疗中老年移位型股骨颈骨折的疗效分析

Comparison of different procedures in the treatment of displaced femoral neck fractures in middle-aged and elderly patients.

目的评价不同手术方法治疗中老年移位型股骨颈骨折的疗效。方法回顾性分析2006年1月至2009年6月收治的80例分别采用内固定(A组,25例)、人工股骨头置换(B组,27例)及全髋关节置换(C组,28例)手术治疗的中老年移位型股骨颈骨折患者资料,分析比较其住院时间、手术时间、术中出血量、术后并发症、术后Harris评分总分及分类评分等指标。结果 A组手术时间最短,术中出血量最少,C组手术时间最长,术中出血量最多;A组术后并发症发生率较B、C组高;随访结果B组Harris评分最低,C组最高;分类评分中C组的疼痛评分较B组高;功能评分C组最高,B组最低,以上差异均有统计学意义。A组、B组、C组住院时间差异及三组患者间的行走评分、活动度评分差异均无统计学意义。结论空心加压螺钉内固定适于相对年轻,骨质条件好,伤前活动能力较好且术后能耐受晚期负重的中年患者,全髋置换适于外伤前身体状况良好、术前活动量多、预期寿命较长或已有髋关节疾病的老年患者,人工股骨头置换适于一般情况较差、有较严重内科合并症但术前评估能耐受一般手术的患者。

Objective To evaluate the clinical outcome of the internal fixation and arthroplasty for the displaced femoral neck fractures in the middle-aged and elderly patients.Methods All the 80 middle-aged and elderly patients with displaced femoral neck fractures who had been treated from January 2006 to June 2009 were reviewed.Of them,25 cases received internal fixation（Group A）,27 femoral head arthroplasty（FHA,Group B） and the other 28 total hip arthroplasty （THA,Group C）.Comparisons were made among the 3 groups in hospitalization,operating time,intraoperative bleeding,postoperative complications,and functional recovery.Results The operating time and blood loss in Group C is the most than that in Group A and Group B.Group A have the most postoperative complication,Group B have the least Harris score,Group C have the more pain score than Group B,Group C have the most function score and Group B have the least.Statistical analysis showed that there is a significant difference in operating time,intraoperative bleeding,postoperative complications and postoperative Harris score,and no significant difference in the hospitalization,walking score and motion range.Conclusion Internal fixation can be applied to patients who are relatively young and active,have good quality of bone and can tolerate ambulation lately;THA is suitable for patients with the displaced femoral neck fractures of the elderly those who are active,have good general condition or have relatively longer life expectancy or preexistent hip diseases.FHA is suitable for patients who have a poor general condition or have serious medical diseases but can tolerate general surgery in preoperative assessment.