不同手术方式治疗老年性股骨颈骨折疗效对比分析

Comparative analysis on different surgeries in the treatment of elderly patients with femoral neckfracture

目的探讨半髋关节置换术、全髋关节置换术和切开复位内固定术治疗老年性股骨颈骨折疗效，为治疗老年性股骨颈骨折提供临床依据。方法收集149例老年股骨颈骨折的患者临床资料，其中采用半髋关节置换术53例（A组）、全髋关节置换术41例（B组），切开复位内固定术55例（c组），比较了i种手术方式的时间、术中失血量和术后下地活动时间，并在1-3年回访采用Harris评分比较不同方式的疗效。结果A、B组的术后下地活动时间显著短于C组（P〈0．05）;但C组的手术时间及术中出血量显著少于A、B组沪〈0．05、A、B、C组Harris评分分别为（893±6．5）、（86．2±5．8）、（84．4±4．4）;A、B、C组优良率分别为94．34％、85．4％、64．8％，A、B组的Harris得分及优良率显著高于C组（P〈0．05）。结论髋关节置换术和切开复位内固定术均可用于治疗老年性股骨颈骨折，全髋及半髋关节置换术在手术下地活动时间及Harris得分等具有优越性，在骨折类型、患者状况及经济条件允许下推荐全髋或半髋置换术。

Objective To compare the clinical efficacy of hemiarthroplasty （HA）, total hip arthroplasty （THA） and open reduction and internal fixation in the treatment of elderly patients with femoral neck fracture.Methods A total of 149 cases of elderly patients with femoral neck fracture were collected, 53 cases underwent HA （group A）, 41 cases underwent THA （group B） and 55 cases underwent open reduction and internal fixation （group C）. Operating time, volume of blood loss in the surgery, time of staying in bed and 1-3 years of follow-up clinical efficacy of the three groups were observed and analyzed with Harris hip scores. Results The time of staying in bed of A and B was shorter than that of C group with significant difference （P〈0.05）; the operation time and the blood volume of group A and B were more than those of group C with significant difference （P〈0.05）; Harris score of group A, B and C were （893±6.5）、（86.2±5.8）、（84.4±4.4）; respectively, the good rate of group A, B and C were 94.34 %, 85.4 % and 64.8 % respectively, Harris score andgood rate of group A and B compared with group C with significant difference （P〈0.05）. Conclusions HA and THA were better than internal fixation operation in surgical injury and Harris score, we recommended HA and THA with fracture type, patients state and economic conditions allowed.