3种不同金属植入物置入治疗高龄患者新鲜股骨颈骨折:2年随访

Three kinds of metal implants for the treatment of fresh femoral neck fracture in elderly patients: 2-year follow-up

背景:目前老年股骨颈骨折的治疗方法仍以内固定术和人工髋关节置换为主,但这些术式的适应证及利弊尚存在诸多争议。目的:比较空心螺钉内固定、人工股骨头置换和全髋关节置换在治疗高龄患者新鲜的移位性股骨颈骨折中的疗效与价值。方法:对108例65岁以上新鲜股骨颈骨折患者分别采用空心螺钉内固定、人工股骨头置换和全髋关节置换治疗,比较治疗后关节功能、并发症以及二次翻修率等方面的差异。结果与结论:空心螺钉内固定组住院时间最长和卧床时间最长,并发症最高,2年随访功能最差。全髋置换卧床时间短,并发症和手术翻修率低,置换后髋关节功能最好,但手术时间最长创伤较大,对患者身体一般状况要求较高。人工股骨头置换创伤比全髋置换稍小,但并发症发生率、翻修率较高,置换后功能比全髋置换差。表明全髋关节置换治疗老年移位性股骨颈骨折,特别是活动能力要求较高、身体一般状况好的老年患者效果较好。

BACKGROUND： At present, the internal fixation and total hip arthroplasty are two main methods for the tneatment of femoral neck fracture in elderly patients. But, as for the surgical indications and the pros and cons, there is still a lot of controversy. OBJECTIVE： To analyze the curative effect and the significance of cannulated screw fixation, artificial femoral head replacement and total hip arthroplasty for the treatment of displaced femoral neck fracture in elderly patients. METHODS： 108 cases of 65 years old patients with femoral neck fracture were selected and treated with cannulated screw fixation, artificial femoral head replacement and total hip arthroplasty respectively. The differences of joint function, complications and secondary revision rate were compared. RESULTS AND CONCLUSION： In cannulated screw fixation group, the hospitalization time, bed time and the complications were higher than those in other two groups, and the 2-year follow-up function was the worst. The total hip arthroplasty had the short bed time, low complication and surgical revision rate and the best hip function after operation, while the longest operation time and bigger trauma required the patient had a higher general condition. The trauma of artificial femoral head replacement was smaller than that of the total hip arthroplasty, but the complication rate and the revision rate were higher and the function after total hip replacement was poor. Total hip arthroplasty for the treatment of displaced femoral neck fractures in elderly patients requires high activity and good general condition of the elderly patients which can lead to a good curative effect.