老年骨质疏松性股骨颈骨折关节置换的选择:是人工股骨头还是全髋关节?

Ideal choice of joint replacement for osteoporotic femoral neck fractures in elderly patients:Hemiarthroplasty or total hip arhtroplasty

背景:目前老年股骨颈骨折主要通过髋关节置换来进行关节功能重建,重建形式包括人工股骨头置换(单极或双极)和全髋关节置换。目的:评价人工股骨头置换(双极与单极)与全髋关节置换对60岁以上老年骨质疏松性股骨颈骨折的临床疗效。方法:应用计算机检索1990-01/2011-05PubMed数据库相关文章,检索词"femoral neck fracture,unipolar hemiarthroplasty,bipolar hemiarthroplasty,total hip arthroplasty",并限定文章语言种类为English。同时计算机检索1990-01/2011-05万方数据库相关文章,检索词"股骨颈骨折,单极人工股骨头置换,双极人工股骨头置换,全髋关节置换",并限定文章语言种类为中文。共检索到文献516篇。结果与结论:老年人股骨颈骨折有多种治疗方式,其中人工股骨头置换不能达到髋关节的解剖复位及功能复位,因此只作为对功能恢复及生活质量要求不高患者的处理方案。全髋关节置换后关节功能的恢复、疼痛率及置换翻修率均优于人工股骨头置换,因此是60岁以上骨质疏松性股骨颈骨折患者的首选治疗方案。

BACKGROUND： Femoral neck fractures in the elderly are frequent, especially those suffering from osteoporosis. Hip arthroplasty is the major method for treatment, which includes unipolar or bipolar hemiarthroplasty （HA） and total hip arthroplasty （THA）. OBJECTIVE： To evaluate the clinical effects of HA and THA for femoral neck fractures in patients over 60 years old suffering from osteoporosis. METHODS： A computer-based online search of Wanfang and PubMed databases was retrieved for articles published between 1990 and 2011 using the keywords of ＂femoral neck fractures, unipolar hemiarthroptasty, bipotar hemiarthroplasty, total hip arthroplasty＂ in Chinese and English. Totally 516 articles were retrieved. RESULTS AND CONCLUSION： Many kinds of surgical methods can be selected for femoral neck fractures in the elderly. By the method of HA, anatomic and functional reduction can hardly be achieved. HA, therefore, should only be selected for patients with tow functional demands and limited life expectancy. THA is a better choice than HA, as regard to the functional recovery, pain rate and reoperation rate. In conclusion, THA is the first choice for femoral neck fractures in patients over 60 years otd who suffer from osteoporosis.