不同手术方法治疗老年股骨颈骨折的对比研究

Comparison of three different surgical treatment for femoral neck fractures in elderly

目的比较分析不同的手术方法对老年股骨颈骨折患者的临床疗效及预后。方法回顾了2012年1月至2015年1月期间本院收治的712例老年股骨颈骨折患者,根据病情和治疗方法分为三组,IF组为闭合复位空心钉内固定(n=206),HA组为半髋关节置换组(n=393),THA组为全髋关节置换组(n=113)。比较三组患者的一般状况、住院时间、受伤至手术时间、手术时间、术中出血量、术后主要并发症、治疗费用、术后1年死亡率及老年髋部骨折功能恢复量表(functional recovery scale,FRS)评分,评价疗效。结果 IF组在住院天数、受伤至手术时间以及术后下肢静脉血栓形成方面明显低于HA组及THA组,三组在手术时间、术中出血量、住院花费方面差异均具有显著性,且IF组<HA组<THA组;在术后1年内死亡率、术后1年FRS评分三组差异无显著性。结论无移位与移位的老年股骨颈骨折治疗存在巨大差异,然而在术后1年死亡率及早期髋关节功能方面差异无显著性。对于移位的老年股骨颈骨折,使用半髋关节置换或全髋关节置换治疗安全、可靠,均可获得满意近期疗效。

Objective To compare three different surgical treatment for femoral neck fractures in elderly. Method Medical records of 712 patients with femoral neck fracture aged≥60 years who underwent close reduction and internal fixation（IF） hemiarthroplasty（HA） total hip arthroplasty（THA） respectively were reviewed. Expenditure, complications and mortality and FRS were assessed. Result In terms of inpatient duration, interval from initial injury to operation date and formation of DVT, the three group had significantly statistical differenc： IF〈HA〈THA, while no statistical difference showed in one year mortality and FRS within the three groups. Conclusion There were significant difference between management of nondisplaced and displaced geriatric femoral neck fracture. However no statistic difference between the two type fractures were confirmed concerning one year mortality and FRS. As far as displaced geriatric femoral neck fracture is concerned, THA and semi hip replacement are safe and reliable method which may achieve short term satisfied results.