人工股骨头置换术与全髋关节置换术治疗老年人股骨颈骨折的疗效比较

Comparison of the effect of the artificial femoral head replacement and the total hip arthroplasty in the treatment of elderly patients with femoral neck fracture

目的 比较人工股骨头置换术与全髋关节置换术治疗老年人股骨颈骨折的临床疗效.方法 选择老年股骨颈骨折患者100例,按随机数字表法分为两组,分别行人工股骨头置换术（A组）和全髋关节置换术（B组）,每组均为50例.比较两组手术出血量、手术时间、住院时间,术后1年髋关节功能Harris评分、视觉模拟评分（VAS评分）、全身健康状况评分（SF-36评分）和并发症及再次手术率.结果 A组手术出血量、手术时间、住院时间分别为（328.2±25.7）mL、（77.6±6.8）min和（20.7±1.8）d,显著低于B组的（359.5±27.6）mL、（97.1±6.2）min、（25.2±2.0）d（t=3.67、4.12、3.25,均P＜0.05）.B组术后Harris评分和SF-36评分分别为（64.7±6.4）分和（76.8±10.1）分,显著高于A组的（59.1±5.8）分和（73.3±9.2）分（t=2.89、2.77,均P＜0.05）;而VAS评分为（2.2±0.7）分,显著低于B组的（3.1±0.9）分（t=4.05,P＜0.05）.B组再次手术率为2.0%,低于A组的6.0%（P=0.047）;两组肺部感染率和股骨头坏死率差异无统计学意义（P＞0.05）.结论 人工股骨头置换术和全髋关节置换术治疗老年人股骨颈骨折各有优势,应根据具体情况选择合适的手术方法.

Objective To compare the clinical effect of the artificial femoral head replacement and the total hip arthroplasty in the treatment of elderly patients with femoral neck fracture. Methods 100 elderly patients with femoral neck fractures were randomly divided into two groups ,50 cases in each group. Patients in group A received the artificial femoral head replacement,while patients in group B received the total hip arthroplasty. The operation time, blood loss, hospitalization time, Harris hip function score, VAS score, SF-36 score, complications and reoperation rate were compared postoperative 1 year. Results The blood loss, operation time and hospitalization time in A group were （328.2 ± 25.7） mL, （77.6 ±6.8 ） rain and （20.7 ± 1.8 ） d, which were significantly lower than （359.5 ± 27.6） mL, （97.1± 6.2） rain, （25.2 ± 2. 0） d of B group （ t = 3.67,4.12,3.25, all P 〈 0.05 ）. The Harris knee function score and SF-36 quality of life after operation in B group were （ 64.7 ± 6.4） points and （76.8 ± 10.1 ） points, which were significantly higher than （59.1 ± 5.8 ） points and （73.3 ± 9.2 ） points in A group （ t = 2.89,2.77, all P 〈 0.05 ）. While the VAS score of group A was （ 2.2 ± 0. 7 ） points, which was significantly lower than （ 3.1 ± 0.9 ） points of B group（ t = 4.05, P 〈 0. 05 ）. The reoperation rate of the B group was 2.0%, which was significantly lower than 6.0% of A group（P = 0.047 ）. The incidence rate of pulmonary infection and necrosis of the femoral head between the two groups had no significant differences （ P 〉 0.05 ）. Conclusion The artificial femoral head replacement and the total hip arthroplasty in the treatment of elderly patients with femoral neck fractures have their advantages. The operation method should be chosen according to the particular case.