老年股骨颈骨折行骨折内固定术与全髋关节置换术临床疗效比较

目的探讨比较骨折内固定术与全髋关节置换术治疗老年股骨颈骨折患者临床疗效。方法回顾性分析2010年6月至2013年2月期间70例随访〉1年的老年股骨颈骨折患者临床资料，其中采用骨折内固定术治疗32例、全髋关节置换术治疗38例，通过比较两组患者手术时间、术中出血量、住院时间、术后卧床时间、并发症及术后髋关节功能恢复情况等，对两组术式进行疗效评价。结果内固定组手术时间、术中出血量、住院时间及术后卧床时间分别为（55．6±12．6）min、（102．2±13．4）ml、（25．2±3．8）d、（368±4．6）d。全髋关节置换组相应指标分别为（96．8±14．4）min、（392．3±32．8）ml、（16．8±1．6）d、（16．4±2．9）d。两组间差异有统计学意义（P〈0．05）。内固定组术后1年相关并发症发病率（37．5％）高于全髋关节置换组（13．2％），且差异有统计学意义（P〈0．05）。内固定组术后1年Harris髋关节功能评分优良率（65．7％）低于全髋关节置换组（84．2％），且差异有统计学意义（P〈0．05）。结论采用全髋关节置换术治疗老年股骨颈骨折，与内固定术比较，能有效缩短卧床时间，减少术后并发症，提高髋关节功能，是目前治疗老年股骨颈骨折的理想方法。

Objective To investigate the clinical efficacy of fracture fixation and hip replacement for the treatment of femoral neck fracture in elderly patients. Methods Retrospective analysis of 70 femoral neck fracture in elderly patients in our hospital from June 2010 to February 2013, which were followed up for 1 year or more. 32 cases were treated with fracture fixation, 38 cases were treated with hip replacement. Compare the operative time, blood loss, complication and hip recovery of the two procedures. Resutls The operative time, blood loss, hospital stay time and postoperative bed rest time ofthe fracture fixation group were （55.6±12.6） min, （102.2±13.4） ml, （25.2±3.8） days and （36.8±4.6） days; The corresponding indicator of the hip replacement group were （ 96.8 ± 14.4 ） min, （ 392.3 ± 32.8 ） ml, （ 16.8 ± 1.6 ） days and （ 16.4 ± 2.9 ） days; The differences between the two groups had statistical significance （ P〈0.05 ） . The postoperative complication of the fracture fixation group （ 37.5% ） was significantly more than that of the hip replacement group （ 13.2% ） （ P〈0.05 ） . The postoperative Harris hip score of the fracture fixation group （ 65.7% ） were significantly less than that of the hip replacement group （ 84.2% ） （ P〈0.05 ） . Conclusion Hip replacement is an ideal way to femoral neck fracture in elderly patients, which can effectively reduce hospital stay time, postoperative bed rest time and postoperative complication.