髋关节置换治疗老年移位股骨颈骨折的术式选择

Options of arthroplasty for treatment of displaced femoral neck fracture in elder

目的 探讨老年（＞65岁）移位股骨颈骨折人工关节置换术的适应症及术式选择.方法 2003年1月-2008年6月共收治108例移位股骨颈骨折患者,年龄65～90岁,平均76.8岁,全部骨折为Garden Ⅲ或Ⅳ型.全髋关节置换（THA组）62例,人工双极股骨头置换（BH组）46例,随访36～60个月,平均45.6个月.分别比较两组手术时间、术中出血量,术后1年及3年髋关节功能（Harris评分）.结果 手术时间：THA组为（97.42±12.27）min,BH组为（71.74±10.86）min,两组比较差异有显著性（P＜0.05）;术中出血量：THA组为（343.71±64.10）ml,BH组为（306.41±74.33）ml,两组比较差异有显著性（P＜0.05）;1年Harris评分：THA组为（89.21±5.98）分,BH组为（87.71±5.76）分,两组比较差异上显著性（P＞0.05l3年Harris评分：THA组为（87.54±6.42）分,BH组为（82.63±9.39）分两组比较差异有显著性（P＜0.05）.结论 全髋关节置换较双极置换手术风险大,但是远期效果好.身体状况好、社会活动多,可耐受手术者应首选全髋关节置换;身体状况差,活动少的选择人工双极股骨头置换.

Objective To explore options and proper indication of arthroplasty for treatment of displaced femoral neck fracture in the elderly patients. Methods From January 2003 to June 2008,108 cases with displaced femoral neck fracture were operated by arthroplasty, at average age of 76.8 years （65～90 years）. All fractures were Garden＇s type Ⅲ orⅣ. 62 cases（THA Group）were total hip arthroplasty and 46 cases （BH Group）were bipolar hemiarthroplasty. All cases were followed up for 36-60 months, with an average of 45.6 months. The operation duration, blood loss and hip function （Harris score） postoperative 1 year and 3 years were compared. Results Operative duration： group THA（97.42±12.27）, group BH （71.74±10.86）;, blood loss： group THA（343.71±64.10）, group BH（306.41±74.33）; 1 year Harris： group THA（89.21±5.98）, group BH（87.71±5.76）; 3-year Harris：group THA（87.54±6.42）, group BH（82.63±9.39）. There were significant differences in operative duration and blood loss between the two groups （P〈0.05）; there was no significant difference in Harris score of postoperation for 1 year （P〉0.05） but there was significant difference（P〈0.05） postoperation for 3 years between the two groups. Conclusions There was a higher risk of total hip arthroplasty than hemiarthroplasty, but it has better long term effect. Total hip arthroplasty was a primary choice for healthy and active patients, while hemiarthroplasty was only recommended for patients with poor health and limited activity before fracture.