全髋关节置换术结合快速康复外科理念治疗老年股骨颈骨折

Total hip arthroplasty combined with fast track surgery concept in the treatment of senile femoral neck fracture

目的探讨全髋关节置换术(THA)结合快速康复外科(FTS)理念治疗老年股骨颈骨折的临床效果。方法 107例行THA治疗的老年股骨颈骨折患者,根据干预方式不同分为FTS组(55例)和对照组(52例),对照组采用传统常规围术期处理方案,FTS组采用FTS围术期处理方案,观察治疗效果。结果 FTS组术后初次下床行走时间(33.3±8.1)h早于对照组的(56.2±8.2)h,术后住院时间(7.5±1.2)d少于对照组(11.7±1.5)d,差异均具有统计学意义(P<0.05)。FTS组术后3 d、术后1周视觉模拟评分法(VAS)评分均低于对照组,差异均具有统计学意义(P<0.05)。FTS组术后1周、术后1个月Harris评分均优于对照组,差异均具有统计学意义(P<0.05),但两组术后6个月Harris评分比较差异无统计学意义(P>0.05)。FTS组并发症发生率为3.6%(2/55),与对照组的9.6%(5/52)比较差异无统计学意义(P>0.05)。结论 THA结合FTS理念治疗老年股骨颈骨折安全有效,能够加速患者康复,不增加并发症的发生,提高了临床疗效。

Objective To investigate clinical effect by total hip arthroplasty （THA） combined with fast track surgery （FTS） concept in the treatment of senile femoral neck fracture. Methods A total of 107 senile femoral neck fracture patients receiving THA for treatment were divided by different intervention measures into FTS group （55 cases） and control group （52 cases）. The control group received conventional perioperative treatment scheme, and FTS group received perioperative FTS treatment scheme. Their curative effects were all observed. Results FTS group had earlier off-bed walk time as （33.3 ± 8.1） h than （56.2 ± 8.2） h in the control group, and it had shorter postoperative stay time as （7.5 ± 1.2） d than （11.7 ± 1.5） d in the control group. Their differences all had statistical significance （P〈0.05）. FTS group had all lower visual analogue scale （VAS） scores in postoperative 3 d and 1 week than the control group, and their differences all had statistical significance （P〈0.05）. F3＂S group had better Harris scores in postoperative 1 week and 1 month than the control group, and their differences all had statistical significance （P〈O.05）, while there was no statistically significant difference of Harris score in postoperative 6 months between the two groups （P〉0.05）. FTS group had incidence of complications as 316% （2/55）, which was 9.6% （5/52）, and their difference had no statistical significance （P〉O.05）. Conclusion Combination of THA and FTS concept shows safety and effectiveness in treating senile femoral neck fracture. This method can accelerate rehabilitation in patients without increased complications, along with improved clinical effect.