不同方式修复老年新鲜股骨颈骨折的对比

Comparison of different ways of repairing fresh femoral neck fracture in the elderly

背景:修复老年人股骨颈骨折以内固定和人工髋关节置换为主,但这些修复适应证的选择及利弊尚存诸多争议。目的:对比分析闭合复位内固定、切开复位内固定+关节囊减压和全髋关节置换对于老年新鲜股骨颈骨折的修复效果。方法:回顾性调查分析213例新鲜股骨颈骨折患者的临床资料,根据骨折类型分无移位型(A组)和移位型(B组);根据修复方式将A组分为闭合复位内固定(A1)、切开复位内固定+关节囊减压(A2)、全髋关节置换(A3),同理将B组分为B1、B2、B3。随访1-3年,从治疗后并发症、治疗后Harris评分、手术时间、术中出血量、治疗后下地时间、治疗后负重时间方面进行比较分析。结果与结论:A2组Harris评分显著优于A1、A3组,B2组Harris评分显著优于B1、B3组;B2组股骨头缺血性坏死发生率显著低于B1组。闭合复位内固定、切开复位内固定+关节囊减压手术时间、术中出血量均显著优于全髋关节置换,但术后下地时间、术后负重时间较全髋关节置换差。提示对于绝大多数老年新鲜股骨颈骨折,首选考虑解剖复位,使用可靠的内固定,可优先选用切开复位空芯拉力螺纹钉内固定+关节囊减压治疗,并尽可能在伤后6-12 h内完成。全髋关节置换则应根据患者具体情况与术者经验,按照其适应证综合分析,慎重选用。

BACKGROUND：The internal fixation and total hip replacement are two main methods for the treatment of fresh femoral neck fracture in elderly patients. But, the surgical indications and the pros and cons stil have a lot of controversies. OBJECTIVE：To compare the effects of closed reduction and internal fixation, open reduction and internal fixation＋joint capsule decompression, and total hip replacement in the treatment of fresh femoral neck fracture in elderly patients. METHODS：A retrospective study of clinical data among 213 patients with femoral neck fractures was performed. Depending on the type of fracture, the involved patients were divided into non-displacement （A group） and displacement （group B）;according to operation methods, the A group was further assigned into closed reduction and internal fixation （A1）, open reduction and internal fixation＋joint capsule decompression （A2）, and total hip replacement （A3）;in the same way, the B group was assigned into B1, B2, B3. Patients were fol owed up for 1-3 years, the operative time, intraoperative blood loss, postoperative ambulation time, postoperative weight-bearing time, postoperative complications, and postoperative Harris scores were compared. RESULTS AND CONCLUSION：Harris score in A2 group was significantly better than the A1 and A3 groups, Harris score in B2 group was also significantly better than the B1 and B3 groups. The incidence of avascular necrosis in B2 group was significantly lower than that in B1 group. The operative time and intraoperative blood＆nbsp;loss in the A1 and A2 groups were significantly better than the A3 group, but postoperative ambulation time and postoperative weight-bearing time were significantly less. For the vast majority of the elderly patients with fresh femoral neck fracture, the preferred treatment is anatomical repositioning using reliable internal fixation, open reduction and hol ow tension screw internal fixation＋joint capsule decompression is pronounced, and the treatment is suggested to be completed within 6-12 hours after injury. Total hip replacement should be considerably selected based on the specific circumstances of patients, the surgeon experience, and comprehensive analysis of surgical indications.