人工关节置换术治疗老年股骨颈骨折的临床研究

Artificial hip arthroplasty in the treatment of elderly patients with femoral neck fracture

目的:探讨人工髋关节置换术用于治疗老年股骨颈骨折的疗效及康复效果。方法:96例老年股骨颈骨折患者根据手术方式分组,32例行人工髋关节置换术治疗者作为A组,另64例实施AO加压空心螺钉内固定治疗者作为B组,对比两组的疗效、康复效果与生活质量。结果:A组的手术时间、术中出血量及住院时间均显著多于B组(P<0.05);A组术后12个月的Harris评分均显著高于B组(P<0.05),而术后18个月时组间比较无明显差异(P>0.05);术后12个月,A组的关节功能优良率为83.33%,显著高于B组的70.31%(P<0.05),术后18个月,A组和B组的关节功能优良率分别为90.63%、85.94%,组间比较并无明显差异(P>0.05);A组的并发症发生率为15.63%,显著低于B组的4.69%(P<0.05);术后18个月,A组的SF-36评分显著高于B组(P<0.05)。结论:人工关节置换术的创伤较内固定治疗更大,但能够更好地改善老年患者的术后关节功能以及生活质量,降低并发症,更具有临床应用价值。

Objective：To evaluate the efficacy of artificial hip arthroplasty in the treatment of elderly patients with femoral neck fracture.Methods：Ninety-six elderly patients with femoral neck fracture were randomly divided into group A（n=32）and group B（n=64）.Group A received artificial hip arthroplasty while group B received internal fixation with AO compression cannulated screw.The clinical and rehabilitation efficacy of the two groups were compared.Results：The operative time,blood loss in operation and hospital stay were significantly more in group A than those in group B（P〈0.05）.Harris scores 12 months after operation were significantly higher in group A than that in group B（P〈0.05）,whereas no significant difference were found between the two groups 18 months after operation（P〈0.05）.Joint function excellent rate 12 months after operation was higher in group A（83.33%）than that in group B（70.31%）（P〈0.05）.But there was no significant difference in joint function excellent rate 18 months after operation between the two groups（90.63% vs 85.94%,respectively）（P〈0.05）.Incidence of complications was significantly lower in group A（15.63%）than that in group B（4.69%）（P〈0.05）.SF-36 scores 18months after operation were significantly higher in group A than that in group B（P〈0.05）.Conclusion：Although it can lead to even larger wounds in elderly patients with femoral neck fracture compared with the internal fixation,artificial hip arthroplasty can improve postoperative joint function and quality of life,and with less complications and more clinical values.