高龄股骨颈骨折全髋与半髋方式的选择

Total hip replacement or hemiarthroplasty for elder femur neck fracture patients

背景:近年来高龄股骨颈骨折患者大量增加,而75岁以上患者选择全髋或半髋关节置换的手术方式仍有较大争议,合理选择手术方式,对增加手术安全性、改善患者髋关节功能、提高生活质量、降低置换后并发症、减少翻修率具有重要意义。目的:对75岁以上患者行髋关节置换的相关资料进行回顾分析,比较二者间优劣,试图寻找更加准确的手术适应证。方法:纳入171例全髋(观察组)和半髋(对照组)关节置换患者的病例资料,其中观察组51例、对照组120例。通过对两组患者基础疾病、手术时间、出血量、置换后并发症、置换后住院日、置换后1周、3个月髋关节Harris评分等方面来比较二者差异。结果与结论:两组患者经过3-39个月(平均23个月)随访,二者在置换前基础疾病、平均年龄、置换后住院日、置换后并发症及置换后1周Harris评分方面进行比较,差异无显著性意义(P>0.05);而在假体置入后3个月Harris评分及优良率方面,观察组效果优于与对照组(P<0.05)。结果说明严格选择手术适应证,两种手术方式均能达到较好的短期疗效,使高龄患者髋关节功能较早恢复,显著提高了患者的生活质量。而高龄患者行全髋关节置换后3个月关节功能恢复相对较好,并发症发生率并未明显增加,提示即使高龄患者,只要做好充分置换前准备工作,仍建议优先选择全髋关节置换。

BACKGROUND：Recently, the number of elder patients with femoral neck fracture increased. It is controversial if patients aged over 75 years should receive total hip replacement or hemiarthroplasty. To select a reasonable surgical manner is of great significance for increasing surgical safety, improving hip joint function, elevating quality of life, decreasing postoperative complications, and reducing revision rate. OBJECTIVE：To retrospectively analyze data of patients aged over 75 years after hip replacement, to compare the advantages and disadvantages, and to find a precise indication. METHODS：Case data of 171 patients undergoing total hip replacement （observation group） （n=51） or hemiarthroplasty （control group） （n=120） were included. Their differences were compared using basic diseases, operation time, bleeding amount, postoperative complications, postoperative hospitalization day, Harris score at 1 week and 3 months after operation. RESULTS AND CONCLUSION：Patients in both groups were fol owed up for 3 to 39 months （averagely 23 months）. No significant difference in basic diseases, average age, postoperative complications, postoperative hospitalization day, and Harris score at 1 week was detected between the two groups （P〉0.05）. Harris score and excellent and good rate at 3 months were better in the total hip replacement group than that in the hemiarthroplasty group （P〈0.05）. Results indicated that strict choice of indication achieved good short-period efficiency in two groups. Thus, hip function of elder patients was early recovered. Quality of life was obviously elevated. The recovery of hip function was relatively better at 3 months in observation group. The incidence of postoperative complications did not increase obviously. These results suggested that besides sufficient preparation, total hip replacement should be the first choice for elder patients.