人工股骨头置换术与全髋关节置换术治疗骨质疏松性股骨颈骨折的临床效果

Clinical effect of prosthetic replacement and total hip replacement in the treatment of osteoporotic femoral neck fracture

目的观察人工股骨头置换术与全髋关节置换术治疗骨质疏松性股骨颈骨折的临床效果。方法回顾性分析2012年8月~2015年2月北京中医药大学东直门医院收治的98例骨质疏松性股骨颈骨折患者的临床资料,按照手术方式的不同将其分为人工股骨头置换术组（46例）、全髋关节置换术组（52例）。比较两组患者手术时间、术中出血量及住院时间,记录两组术后12个月Harris髋关节功能评分并评价其疗效,观察两组术后12个月并发症发生情况。结果全髋关节置换术组手术时间[（126.44±35.91）h]明显长于人工股骨头置换术组[（94.58±23.72）h],术中出血量[（452.64±66.78）m L]明显多于人工股骨头置换术组[（310.37±52.75）m L],差异均有统计学意义（均P〈0.05）。两组住院时间比较差异无统计学意义（P〉0.05）。全髋关节置换术组术后12个月髋关节功能优良率为90.38%,人工股骨头置换术组为80.43%,两组髋关节功能优良率比较差异有统计学意义（P〈0.05）。术后随访12个月及以上,人工股骨头置换术组并发症发生率为8.70%,全髋关节置换术组并发症发生率为9.62%,两组并发症发生率比较差异无统计学意义（P〉0.05）。结论人工股骨头置换术与全髋关节置换术治疗骨质疏松性股骨颈骨折各有利弊,因此需严格术前评估,针对不同患者采用不同的术式,对于伤前活动能力较弱、全身情况较差的高龄患者宜采用人工股骨头置换术,对于伤前活动能力较强、身体健康状况较好的患者宜采用全髋关节置换术。

Objective To observe the clinical effect of a prosthetic replacement and total hip replacement in the treatment of osteoporotic femoral neck fracture. Methods The clinical data of 98 cases with osteoporotic femoral neck fracture admitted to Dongzhimen Hospital, Beijing University of Chinese Medicine from August 2012 to February 2015 was analyzed retrospectively. The patients were divided into prosthetic replacement group（46 cases） and total hip replacement group（52 cases） according to different surgical methods. The operation time, intraoperatve blood loss and the hospital stay of the two groups were compared; the Harris hip scores of the two groups after operation for 12 months were recorded and the effects were evaluated; the complications after operation for 12 months of the two groups were observed. Results The operation time [（126.44±35.91）h] of total hip replacement group was longer than that of prosthetic replacement group [（94.58±23.72）h], the intraoperatve blood loss [（452.64±66.78）m L] was more than that of prosthetic replacement group [（310.37±52.75）m L], and the hospital stay between the two groups had no statistically significant difference（P 0.05）. The excellent and good rate of hip joint function after operation for 12 months in total hip replacement group was 90.38%, which of prosthetic replacement group was 80.43%, the difference between the two groups was statistically significant（P 0.05）. Followed-up for 12 months or more after operation, the incidence of complications in prosthetic replacement group was 8.70%, which of total hip replacement group was 9.62%, the difference of the incidence of complications between the two groups was not statistically significant（P 0.05）. Conclusion Prosthetic replacement and total hip replacement in the treatment of osteoporotic femoral neck fracture has merits and demerits respectively, so it is necessary to take the preoperative assessment strictly, different patients should take different surgical methods. Elderly patients with weak activities before injury and bad general physical conditions should take prosthetic replacement, while the patients with strong activities before injury and good general physical conditions should take total hip replacement.