高龄股骨颈基底型骨折人工关节置换与内固定术后生活质量评价

Comparison of the postoperative quality of life between internal fixation and hemiarthroplasty for the elderly with femoral neck basement fracture

背景:股骨颈基底型骨折属于股骨颈骨折,同时又是囊外骨折,治疗方法有多种选择,由于发生率低故相关研究甚少。目的:比较分析高龄(70岁以上)股骨颈基底型骨折行人工股骨头置换与闭合复位内固定患者术后生活质量差异。方法:1995年9月至2009年6月共收治38例股骨颈基底型骨折患者,男12例,女26例;年龄70～91岁,平均79.4岁;全部患者均为外伤性新鲜骨折,其中16例选择人工股骨头置换为一组,另22例选择内固定术为一组。对比两组患者手术时间、术中出血量、术后下地时间及术后1年运用Harris评分中部分项目评定患者生活质量并结合术后1年髋部正侧位X线片。结果:两组在手术时间、术中出血量、术后下地时间等比较,差异有统计学意义(P<0.001)。人工股骨头置换组在1年后生活自理、髋部疼痛及行走距离等方面较内固定组优异。人工股骨头置换组1年后均未出现假体松动,而内固定组骨折均愈合。结论:人工股骨头置换术治疗高龄股骨颈基底型骨折近期效果较理想,具有以下优点:(1)术后可早期负重活动,较快恢复伤前活动能力;(2)降低术后并发症和内科合并症的发生几率;(3)近期感觉及功能优于内固定。但同时股骨颈基底型骨折作为囊外骨折血供较好,骨折愈合率高,对于预期生存时间超过5年、骨质量较好的老年患者考虑行内固定治疗,可避免人工关节置换后期的磨损、松动及下沉。

Background： The femoral neck basement fracture is classified as both femoral neck fracture and extracapsular fracture. Sowe have many choices of treatment for it. However, there are few studies on it for low incidence rate.Objective ： The aim of the present study is to compare the postoperative quality of life in aged patients （ 70 years old and a- bove） who had undergone the hemiarthroplasty versus internal fixation, with femoral neck basement fracture.Methods： From September 1995 to June 2009, 38 patients with femoral neck basement fracture （ 12 males, 26 females, aged 70 -91 years old with an average of 79. 4 years）. Of them, 22 undergone hemiarthroplasty and 16 were treated by in- ternal fixation, and all injuries were fresh fractures. Operative time, blood loss and the time of postoperative weight loading were compared between the two types of treatment. The quality of life was assessed by Harris score and anteroposterior and lateral X-ray one year after operation.Results： The difference of operative time, blood loss and the time of postoperative weight loading between the two types of treatment }lad statistic signifieance （P 〈0. 001 ）. The activities of daily living, hip pain and walking distance in hemiar- throplasty group were better than that in internal fixation group. There was no prosthesis loosening in hemiarthroplasty group and all the fracture healed in internal fixation group.Conclusions： Hemiarthroplasty for the treatment of the aged femeral neck basement fracture are satisfactory, with the fol- lowing advantages： （ 1 ） early loading activities after operation; （2） lower risk of postoperative complications and medical complications; （3） short-term feeling and function of hip joint are better than internal fixation. On the other hand, being extracapsular fracture, the femoral head of the femoral neck basement fracture has a good blood supply and healing rate of fracture is high. Therefore, internal fixation is also a good choice for the elder patients of expected survival life over 5 years with a good bone quality. It can avoid the long-term complication of artificial joint replacement such as loosening, sinking and wear.