人工股骨头置换术与全髋关节置换术治疗老年股骨颈骨折临床效果比较

Comparison of clinical effect between artificial femoral head replacement and total hip arhtroplasty on the fracture of neck of femur of elderly

目的比较人工股骨头置换术和全髋关节置换术治疗老年股骨颈骨折的临床效果。方法选择2010年4月—2012年6月本院骨科收治的老年股骨颈骨折患者120例,随机将其均分为3组,每组40例,分别行传统空心加压螺钉内固定术(D组)、人工股骨头置换术(G1组)、全髋关节置换术(G2组)。比较各组患者的平均手术时间、失血量、住院时间以及PSQI评分,各组患者术后2年髋关节功能Harris评分和SF-36生活质量评分。结果 G1组和G2组的手术出血量、手术时间以及住院时间,显著高于D组(P<0.05);G2组和G1组2年后髋关节Harris评分优良率分别为82.5%和72.5%,2组优良率均显著高于D组(P<0.05);G1组和G2组生活质量总评分和PSQI评分分别为(72.72±5.27)、(77.31±5.14)分,(6.25±2.64)、(10.11±2.93)分,均显著高于D组(P<0.05);G1组和G2组再次手术率、肺部感染以及股骨头坏死等并发症率显著低于D组(P<0.05)。结论人工股骨头置换术和全髋关节置换术与传统空心加压螺钉内固定术,在治疗老年股骨颈骨折各有优缺点,应根据股骨颈骨折的具体情况选择相应的手术方法。

Objective To compare clinical effect of artificial femoral head replacement and that of total hip arhtroplasty on the fracture of neck of femur in elderly patients. Methods A total of 120 elderly patients with femoral neck fracture admitted to our hospital from April 2010 to June 2012 were selected and were randomly divided into three groups, each group containing 40 cases. The first group received traditional hollow compression screw internal fixation （D group）. The second group received artificial 1 femoral head replacement （O1 group）. The third group received total hip arthroplasty （02 group）. The average operation time, blood loss, hospital stay and PSQI score were observed and compared. The Harris score and SF-36 score among three groups were compared and analyzed two years after treatment. Results The operation bleeding, operation time and hospital stay of the G1 group and 02 group after treatment were significantly higher than those in the D group （P 〈 0.05）. The Harris hip score for the excellent and good rate of the 02 group and the G-1 group after 2 years were 82.5 % and 72.5 % respectively, significantly higher than those in D group （ P 〈 0.05）. The 8F-36 quality of life score and PSQI score of the G1 group and G2 group were 72. 72 ± 5.27, 77.31 ± 5.14 and 6.25 ± 2.64 and 11 ± 2.93 respectively, significantly higher than that in the D group （ P 〈 0. 0 5 ） . The re - operation rate, lung infection and necrosis of the femoral head and the complication rate of the that of the D group （ P 〈 0.05 ）. Conclusion G1 group and G2 group was significantly lower than It has different advantages and disadvantages among the artificial femoral head replacement and total hip arthroplasty with traditional hollow compression and screw internal fixation of femoral neck fractures in the elderly. The choices of operation method should be made based on the specific circumstances of femoral neck fracture corresponding to the selected operation mode.