全髋与股骨头置换对高龄股骨颈骨折的疗效比较

Applied analysis of different operation methods for elderly femoral neck fracture

目的:比较人工全髋关节置换(total hip arthroplasty,THA)与人工股骨头置换(hemiarthroplasty,HA)对高龄股骨颈骨折的疗效。方法:2007—2013年于南京医科大学第一附属医院接受HA的高龄股骨颈骨折患者385例,其中年龄80~85岁、骨折分型为GardenⅢ、Ⅳ型并获得随访的患者共82例。同期行THA的高龄股骨颈骨折患者共679例,根据患者骨折分型、性别、年龄、身高、体重进行配对,选取同期82例THA患者进行对比研究。记录患者术前察尔森合并症指数(Charlson comorbidity index,CCI)、手术时间、切口长度、出血量、术后并发症、末次随访髋关节Harris评分(Harris hip score,HHS)、住院时间和住院费用。结果:所有患者均获随访,平均4.7年。两组患者末次随访时HHS及术后并发症差异无统计学意义(P>0.05)。HA组在显性失血量、隐性失血量、切口长度、手术时间、住院时间、住院费用方面优于THA组(P<0.05),两组患者术前CCI差异有统计学意义(P<0.05)。结论:HA具有疗效可靠、手术创伤小、住院时间短及住院费用低的优点,是高龄股骨颈骨折的一种良好治疗方式。

Objective：To compare the clinical effects between total hip arthroplasty（THA） and hemiarthroplasty（HA） for elderly femoral neck fracture. Methods： From 2007-2013, 385 elderly femoral fracture patients were treated by HA in the authors’ affiliated hospital. Among these patients, 82 patients（aged 80-85 years old） with the fracture type of Garden Ⅲ and Ⅳ were followed-up. According to these patients’ age, sex, height, weight and the classification of femoral neck fracture, we picked up 82 patients treated by THA for paired analysis. Preoperative Charlson comorbidity index（CCI）, operation time, incision length, blood loss, complications,Harris hip score（HHS） of the last follow-up, hospital stay and expenses were recorded. Results： The mean follow-up time was 4.7years. The difference of preoperative CCI between the two groups was statistically significant（P〈0.05）. In the comparison of dominant blood loss, hidden blood loss, incision length, operative time, length of stay, and hospitalization costs, HA patients were better than THA patients（all P〈0.05）. There were no significant differences in complication and HHS. Conclusion： HA can reduce blood loss,incision length, hospital stay and expenses, and is a good treatment for elderly patients with femoral neck fracture.