髋关节置换术治疗老年人股骨颈骨折和股骨头坏死的临床疗效分析

Analysis of clinical curative effects of hip replacement in the treatment of femoral neck fracture and femoral head necrosis in elderly patients

目的 探讨髋关节置换术治疗老年人股骨颈骨折和股骨头坏死的临床效果.方法 选择老年股骨颈骨折和股骨头坏死患者为研究对象,按照疾病类型分为骨折组（n=35）和股骨头坏死组（n=38）,患者均行髋关节置换术治疗.观察两组手术时间、术中输血量、住院时间、卧床时间、围手术期并发症发生情况.采用Harris评分评估患者术前及术后末次随访时的髋关节功能,同时观察患者术后并发症发生情况.结果 患者均获得随访,随访时间6～24个月,未见切口感染及严重围手术期并发症.骨折组术中出血量（334.9±90.4） mL、手术时间（91.7±14.3）min、住院时间（19.5±7.5）d、卧床时间（5.9±1.6）d,股骨头坏死组术中出血量（362.9±71.5）mL、手术时间（93.5±7.8） min、住院时间（20.5±4.2）d、卧床时间（6.3±1.4）d,两组术中出血量、手术时间、住院时间及卧床时间差异均无统计学意义（均P ＞0.05）.术后末次随访时两组患者的Harris评分均较术前提高,骨折组术后评分（89.0±7.4）分,明显高于股骨头坏死组的（84.0±9.2）分（t=19.639,P＜0.05）.骨折组1例患者于术后1年出现骨折延迟愈合,2例患者术后行走时出现患处疼痛;股骨头坏死组1例患者出现股神经损伤,1例因其原有内科疾病死亡,1例术后行走时出现患处疼痛,两组均无假体松动或脱位现象.结论 髋关节置换术手术时间短、出血量少、术后卧床时间短,对老年人股骨颈骨折和股骨头坏死效果好,并发症发生率低,且对股骨颈骨折患者髋关节功能改善效果更优,值得推广.

Objective To explore the clinical curative effects of hip replacement in the treatment of femoral neck fracture and femoral head necrosis in elderly patients and the existing problems.Methods A total of seventy-five aged patients with femoral neck fracture or femoral head necrosis who were treated by hip replacement were selected as study objects.They were divided into fracture group and femoral head necrosis group according to disease type,all the patients were treated with hip replacement.The surgical time,intraoperative blood transfusion volume,length of hospital stay,in-bed time,perioperative complications and postoperative complications were observed and recorded.The Harris score was used to evaluate hip function of preoperation and postoperation.Results All patients were followed up for 6 ～ 24 months,no incision infection and severe perioperative complications.The volume of intraoperative blood loss,operation time,hospitalization time,in-bed time of the fracture group were （334.9 ± 90.4） mL,（91.7 ± 14.3） min,（19.5 ± 7.5） d,（5.9 ± 1.6） d,respectvely,which of the femoral head necrosis group were （362.9 ± 71.5） mL,（93.5 ± 7.8） min,（20.5 ± 4.2） d,（6.3 ± 1.4） d,respectvely,the differences between the two groups were not statistically significant （all P 〉 0.05）.At the end of the follow-up,the Harris scores of the two groups were higher than before operation,and the score of the fracture group （89.0 ± 7.4） points was significantly higher than （84.0 ± 9.2） points of the femoral head necrosis group （t =19.639,P 〈 0.05）.In the fracture group,1 year after surgery,1 patient appeared delayed fracture healing,2 cases with postoperative pain when walking the affected area.In the femoral head necrosis group,1 case with femoral nerve injury,1 case of death due to its original diseases,1 case of postoperative sore pain when walking,the two groups had no prosthesis loosening or dislocation phenomenon.Conclusion Hip replacement in the treatment of femoral neck fracture and femoral head necrosis in elderly patients can be used as a clinical treatment option with short in-bed time,less intraoperative blood loss,short operation time,less perioperative complication and good treatment effect,and it is worth to be promoted.