全髋与半髋置换术治疗老年人股骨颈骨折疗效比较

Comparation of Clinical Efficacy in Treatment of Femoral Neck Fracture with Total Hip Arthroplasty and Bipolar Hemiarthroplasty in Elderly

目的比较采用全髋关节置换术(total hip arthroplasty,THA)或双极人工股骨头置换术(bipolar hemiarthroplasty,BHA)治疗老年股骨颈骨折的5年临床综合疗效及成本效益(cost effectiveness)。方法 169例70岁以上老年股骨颈骨折患者,分别接受THA(n=54)或BHA(n=115)治疗。对比THA组与BHA组的手术时间、手术切口大小、术中出血量、术后引流量、输血量、平均住院日、平均费用、并发症发生率,术后半年、2年和5年时髋关节功能(Harris评分)及X线评估。结果术后平均随访时间为5.1年(2~5.7年)。THA组的手术时间、术中出血量、术后引流量、输血量、术后脱位率、平均住院费用均高于BHA组,两组平均住院日、手术切口大小、术后5年内Harris评分、并发症发生率、感染率差异无统计学意义;两组中75岁以上患者术后2年及5年时Harris评分、术后5年死亡率差异无统计学意义,但BHA组术后半年时Harris评分高于THA组。结论 THA与BHA治疗老年股骨颈骨折的术后5年临床综合疗效相似,但后者具有手术创伤小、风险低、术后恢复快、成本低等优点,更适用于有较多合并症的高龄体弱患者。

Objective To compare clinical efficacy and cost-effectiveness in treatment of femoral neck fracture with total hip arthroplasty（THA）and bipolar hemiarthroplasty（BHA）in elderly.Methods 169 patients over 70 years old with femoral neck fractures were treated with either THA or BHA.Comparison between THA and BHA groups were carried out on operation duration,incision size,blood loss,postoperative drainage,transfusion volume,average length of hospital stay,average cost,complication rate,hip function（Harris scores）and X-ray assessment.Results The patients were followed up for 2years to 5.7years,with an average follow-up period of 5.1years.The operation duration,amounts of blood loss,postoperative drainage,blood transfusion,postoperative dislocation rate and average cost of THA group were greater than those of BHA group（P〈0.05,respectively）.Differences of average length of hospitalization,incision size,postoperative Harris scores,incidence of complications and infection rates between the two groups were not significant（P〉0.05,respectively）.In the patients over 75 years old,there were not significant differences on Harris scores 2and 5years post-operation and mortality between the two groups（P〉0.05,respectively）.The Harris scores at0.5years post-operation of BHA group was higher than that of THA group（P〈0.05）.Conclusion The clinical efficacy of BHA at mid-term was similar to that of THA in treatment of femoral neck fracture in elderly.However,BHA may be more suitable for patients who are frail and with complications because of it＇s advantage in less surgical trauma and risks,quicker recovery and lower cost than THA.