全髋关节置换术治疗老年股骨颈骨折27例

Total hip replacement in treatment of femoral neck fracture in elders:a study of 27 cases

目的通过与空心钉内固定术治疗股骨颈骨折的疗效进行对比,探讨全髋关节置换术治疗股骨颈骨折的优缺点。方法选择2008年1月～2010年6月在我院进行治疗的股骨颈骨折患者55例,根据随机原则分为全髋关节置换组(27例)和空心钉组(28例),分别采用全髋关节置换术和空心钉内固定术治疗。观察术中和术后情况及临床疗效。结果全髋关节置换组的总有效率显著高于空心钉组,全髋关节置换组平均手术时间显著长于空心钉组,术中出血量也多于空心钉组,住院时间长于空心钉组,但下地活动时间明显早于空心钉组。两组比较,差异均有统计学意义(P<0.01或P<0.05)。结论全髋关节置换术治疗老年股骨颈骨折,可以提高疗效,缩短老年患者的卧床时间,从而减少长期卧床的并发症,但是其手术时间和术中出血量均多于空心钉内固定治疗法,从而增加了术中的风险。因此在临床上,要把握适应证,选择可以耐受的患者进行全髋关节置换术治疗,从而提高疗效,减少并发症的发生。

Objective To discuss the merits and demerits of total hip replacement in treatment of fracture of neck of femur in elders by being compared with hollow nails fixation. Methods From Jan 2008 to Jun 2010, 55 cases who treated with femoral neck fracture in our hospital were randomly divided into total hip replacement group （n = 27） and hollow nails fixation group （n = 28）. Intraoperative and postoperative situation and clinical curative effect were observed. Results The total curative effect rate of the total hip replacement group was higher than the hollow nails fixation group, average operation time and hospital stays were longer than the hollow nails fixation group, peri-operative bleeding was more than the hollow nails fixation group, but ambulation was earlier than the hollow nails fixation group. There were significant difference between two groups （P 〈 0.01 or P 〈 0.05）. Conclusion Total hip replacement in treatment of femoral neck fracture in elders can increase curative effect rate, shorten bedridden time, then reduce the complication of long-term bedrest. But its operation time is longer and peri-operative bleeding is more than hollow nails fixation, which can increase surgical risk. So in clinic, to master idicatio, and select the elderly patients who can cure the total hip replacemen to receive this treatment, can increase the totle curative effect rate and reduce the complications.