全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的临床疗效

Clinical Curative Effect of Total Hip Replacement and Hemiarthroplasty in Treatment of Senile Femoral Neck Fractures

目的探讨老年股骨颈骨折采用全髋关节置换术(THA)和半髋关节置换术(AFHR)治疗的有效性与安全性。方法方便选取2003年3月—2016年6月该院收治的121例老年股骨颈骨折患者为研究对象,依据手术方式分为A组(THA,61例)和B组(AFHR,60例)。对比观察两组基本治疗指标,以Harris评分表评估两组疗效,统计优良率,观察并发症及术后返修率。结果 A组手术时间(90.5±16.7)min,长于对照组,差异有统计学意义(P<0.05);A组术中出血量(273.1±44.2)ml,住院时间(21.4±5.2)d,治疗优良率80.3%,并发症发生率9.9%,术后返修率3.3%,各项指标与B组比较差异无统计学意义(P>0.05)。结论老年股骨颈骨折以THA和AFHR治疗均效果良好,其中THA术后长期并发症少,效果好,适用性强。而AFHR术后关节稳定,不易脱位。对于老年股骨颈骨折患者,身体状态良好,要求较高的选用THA,而对于身体状态欠佳,对活动要求不高的老年人股骨颈骨折患者,则可行AFHR,临床应根据患者实际,酌情选择。

Objective To study the effectiveness and safety of total hip replacement and hemiarthroplasty in treatment of senile femoral neck fractures. Methods 121 cases of senile patients with femoral neck fractures admitted and treated in our hospital from March 2003 to June 2016 were convenient selected and divided into two groups according to operation method, the group A with 61 cases and the group B with 60 cases were respectively treated with THA and AFHR, and the basic treatment indexes of the two groups were compared and the curative effect was evaluated by the Harris Scale, and the excellent and good rate was counted and the complications and postoperative repair rate were observed. Results The operation time in the group A was（90.5±16.7）min, which was longer than that in the control group, and the difference was statistically significant（P〈0.05）, and the intraoperative bleeding amount, length of stay, treatment excellent and good rate, incidence rate of complications and postoperative repair rate in the group A were respectively（273.1 ±44.2）mL,（21.4 ±5.2）d,80.3%, 9.9%, 3.3%, and the differences in these indexes between the two groups were not statistically significant（P〉0.05）.Conclusion The effect of THA and AFHR in treatment of senile femoral neck fractures is good, and the long-term complications after THA surgery are fewer with good effect and strong applicability, but the joint after the AFHR surgery is steady,for senile femoral neck fractures patients in good condition who have a high demand for joint, THA is a good choice, and for senile patients in bad condition who have no high demand for activity, AFHR can be selected, and we should select the operation method according to the practical conditions.