人工股骨头置换与动力髋螺钉治疗老年股骨颈基底部骨折并骨质疏松的疗效比较

Curative effectiveness of artificial femoral head replacement vs.dynamic hip screw for femoral neck basal fracture in elderly patients with osteoporosis

目的分析人工股骨头置换术(artificial femoral head replacement,AFHR)与动力髋螺钉(dynamic hip screw,DHS)内固定在治疗老年股骨颈基底部骨折并骨质疏松患者中的应用,对比两者在疗效上的差异。方法回顾性分析我科2008年6月至2014年6月期间收治的47例老年骨质疏松股骨颈基底部骨折患者,按照手术方式进行分组:AFHR组22例,DHS组25例。详细记录并比较两组患者术中的出血量、术后引流量、手术时间、手术前后血红蛋白量以及术后第6、12个月髋关节功能的Harris评分。根据骨盆平片及患髋侧位X线片观察股骨假体及钢板周围骨质的变化情况。结果 AFHR组的术中出血量、术后引流量、手术时间、手术前后血红蛋白量以及术后髋关节功能Harris评分优于DHS组,差异有统计学意义(P<0.05)。结论对于合并有骨质疏松的股骨颈基底部骨折的老年患者,AFHR手术时间短、出血少、近期髋关节功能恢复良好,临床效果较DHS更具优势。

Objective To compare the curative effectiveness of artificial femoral head replacement （AFHR） vs. dynamic hip screw （DHS） internal fixation for the femoral neck basal fracture in the elderly patients with osteoporosis. Methods A retrospective analysis was performed on 47 elderly patients with femoral neck basal fracture complicated with osteoporosis admitted to our hospital from Jun. 2008 to Jun 2014. Patients were divided into AFHR group （22 cases） and DHS group （25 cases） according to the surgical procedures. The intraoperative blood loss, postoperative drainage volume, operating time, hemoglobin before and after operation, and Harris hip joint function score at 6th and 12th month after operation were compared. The bone changes around the femoral prosthesis and steel plate were observed by the pelvic plain radiographs and lateral hip X-ray. Results Intraoperative blood loss, postoperative drainage volume, operating time, hemoglobin before and after operation, and Harris hip joint function scores postoperation showed significant difference between AFHR group and DHS group （P〈0. 05 for all）. Conclusion In the treatment of the femoral neck basal fracture in elderly patients with osteoporosis, AFHR can improve the hip joint function in a short time, and has the advantages of shorter operating time, less blood loss, and more satisfactory clinical effectiveness than DHS.