人工股骨头置换与加压螺钉内固定治疗老年无移位股骨颈骨折

Comparison of artificial femoral head replacement and compression screw internal fixation in treatment of non-displaced femoral neck fractures of elderly patients

目的比较人工股骨头置换与加压螺钉内固定治疗老年无移位股骨颈完全骨折的手术方法及疗效。方法回顾性分析2010年1月至2015年10月于珠海市第二人民医院骨二科接受手术治疗的236例股骨颈骨折患者。纳入标准:年龄≥60岁、单侧骨折、无移位的股骨颈完全骨折、受伤至手术时间≤7 d、随访时间≥12个月。排除标准:术中使用骨水泥、术前或术后出现偏瘫及其他影响功能评定的合并症。符合纳入排除标准共104例,按术式不同分为两组,人工股骨头置换组60例,加压螺钉内固定组44例。采用统计软件SPSS 13.0,对以下计量指标进行t检验:年龄、住院时间、住院费用、手术时间、术中出血量、初次下地功能锻炼时间、末次随访髋关节Harris功能评分;对以下计数指标进行卡方检验:性别构成、术前合并症、末次随访髋关节Harris功能评分等级;对以下指标进行生存分析:二次手术的时间间隔。结果两组患者年龄(t=0.676,P>0.05)、性别构成(2=0.061,P>0.05)、术前存在合并症(2=0.034,P>0.05)之间的差异没有统计学意义,说明两组患者具有可比性。人工股骨头置换组与加压螺钉内固定组在住院时间(t=4.21,P<0.05)、住院费用(t=9.92,P<0.05)、手术时间(t=11.47,P<0.05)、术中出血量(t=20.93,P<0.05)、术后初次下地时间(t=24.64,P<0.05)方面的差异有统计学意义;加压螺钉内固定组的住院时间、住院费用、手术时间、术中出血量均显著短于或少于人工股骨头置换组;人工股骨头置换组的术后初次下地功能锻炼时间显著短于加压螺钉内固定组。结论对老年无移位的股骨颈完全骨折,加压螺钉内固定治疗优于人工股骨头置换。

Objective To compare the surgical procedures and outcomes of artificial femoral head replacement and compression screw internal fixation in the treatment of non-displaced femoral neck fractures in the elderly patients. Methods A total of 236 patients with femoral neck fractures treated in the orthopaedic department of The second People＇ s hospital of Zhuhai from January 2010 to October 2015 were retrospectively analyzed. Inclusion criteria： age ≥60, unilateral fracture, undisplaced femoral neck fracture, the time from injury to operation is less than 8 d, the follow up time is more than 12 months. Exclusion criteria： bone cement is used, bemiplegia or other complications may affect the functional assessment. A total of 104 patients were enrolled. According to the different surgical methods, the patients were divided into two groups ： the artificial femoral head replacement group （ n = 60） and the compression screw fixation group （n =44）. By using SPSS 13.0, t test was performed on the following continuous variables： age, hospitalization time and cost, operation time, intraoperative blood loss, initial off-bed training interval, Harris hip function score at the end of the follow-up ; Chi-square test was performed on the following discrete variables- gender, preoperative complications, the grades of Harris hip function score at the end of the follow-up. Survival analysis was performed on the revision surgery interval. Results There were significant differences in the hospitalization time （ t = 4. 21, P 〈 0. 05 ） and cost （ t = 9.92, P 〈 0. 05）, operation time （ t = 11.47, P 〈 0. 05 ）, and intraoperative blood loss （ t = 20. 93, P 〈 0. 05 ） between the two groups, which were shorter or less in the compression screw fixation group. The initial off- bed training interval of artificial femoral bead replacement group was significantly shorter than that of the compression screw fixation group （ t = 24. 64, P 〈 0. 05 ）. Conclusion Compression screw fixation for the treatment of non-displaced femoral neck fracture in the elderly patients is better than that of artificial femoral head replacement.