全髋与半髋置换治疗老年股骨颈骨折的比较

Total hip arthroplasty versus bipolar hemi-arthroplasty for the treatment of elderly osteoporotic femoral neck fracture

背景:全髋关节与半髋关节置换是治疗老年骨质疏松性股骨颈骨折较为有效的方法,由于患者身体条件及基础疾病的影响,对关节置换方式的选择是临床需慎重考虑的方面。目的:对比全髋关节置换与半髋关节置换治疗老年骨质疏松性股骨颈骨折的近期疗效。方法:采用人工关节置换治疗骨质疏松性股骨颈骨折75例,全髋置换组38例,平均年龄(68.4±5.3)岁;半髋置换组37例,平均年龄(72.5±6.2)岁,对两组患者置换后Harris评分和Merled-Aubigne-Postel髋关节功能分级,置换中出血量及置换时间,置换后并发症及死亡率进行观察比较。结果与结论:75例患者均获8个月以上随访。两组患者关节置换后髋关节疼痛、髋关节活动范围及髋关节行走能力评分比较,差异无显著性意义(P>0.05)。两组置换后并发症及死亡率比较差异无显著性意义(P>0.05)。全髋置换组平均置换时间长于半髋置换组,置换中出血量显著多于半髋置换组(P<0.05)。提示:对老年骨质疏松性股骨颈骨折患者实施半髋置换,操作时间短,置换中出血少,且置换后疗效与全髋置换相当。

BACKGROUND： Total hip arthroplasty and bipolar hemi-arthroplasty are effective methods for the treatment of elderly osteoporotic femoral neck fracture. Due to the influence of physical condition and the underlying disease, the choice of the way for joint replacement in clinic should be considered carefully. OBJECTIVE： To compare the short-term outcomes of total hip arthroplasty and bipolar hemi-arthroplasty for the treatment of elderly osteoporotic femoral neck fracture. METHODS： Seventy-five patients with osteoporotic femoral neck fracture were treated by artificial jointreplacement, including 38 cases in total hip arthroplasty group and 37 cases in the bipolar hemi-arthroplasty group. The average age was （68.4±5.3） years in the total hip arthroplasty group and （72.5±6.2） years in the bipolar hemi-arthroplasty group. The Harris＇ hip scores, Merled-Aubigne-Postel hip function grades, operative blood loss, replacement time, postoperative complications and mortality were analyzed and compared in these two groups. RESULTS AND CONCLUSION： All the 75 patients were followed-up for more than 8 months. There were no significant differences in the postoperative hip pain, hip joint range of motion and hip walking ability scores between two groups （P 〉 0.05）. There were no significant differences in postoperative complications and mortality between two groups （P 〉 0.05）. The average operation time in the total hip arthroplasty group was longer than that in the bipolar hemi-arthroplasty group, and the operative blood loss in the total hip arthroplasty group was significantly larger than that in the bipolar hemi-arthroplasty group （P 〈 0.05）. The bipolar hemi-arthroplasty for the treatment of elderly osteoporotic femoral neck fracture has the advantages of short operation time and little operative blood loss, and the operative outcome is as good as the total hip arthroplasty. Key Words： bone and joint implants; artificial prosthesis; femoral neck fracture; total hip arthroplasty; bipolar hemi-arthroplasty; hip joint; joint replacement; Harris score; osteoporosis; range of motion