半髋关节置换与空心加压螺钉内固定治疗高龄骨质疏松性股骨颈骨折的疗效对比分析

Comparative analysis of the effects of hemiarthroplasty and cannulated compression screw fixation in the treatment of osteoporotic femoral neck fractures in elderly patients

目的评价半髋关节置换与空心加压螺钉内固定治疗高龄骨质疏松性股骨颈骨折的疗效对比,探讨其临床适用性。方法选择96例高龄骨质疏松性股骨颈骨折患者,根据Garden分型不同,随机分为半髋关节置换术组48例和空心加压螺钉内固定术组48例。观察2组患者的手术时间、术中出血量、术后卧床时间等手术一般情况及手术后并发症发生情况,随访观察患者的髋关节Harris评分变化与治疗效果。结果半髋关节置换术组患者的手术时间和术中出血量分别为(1.99±0.41)h和(236.72±15.88)m L,均高于空心加压螺钉内固定术组患者的(0.91±0.39)h和(88.75±15.85)m L,差异有统计学意义(P<0.05);半髋关节置换术组患者的术后卧床时间低于空心加压螺钉内固定术组[(13.59±3.41)与(40.72±3.38)d,P<0.05];半髋关节置换术组患者优良率为95.45%,空心加压螺钉内固定术组患者优良率为81.82%,2组患者优良率比较,差异有统计学意义(P<0.05)。结论半髋关节置换与空心加压螺钉内固定治疗高龄骨质疏松性股骨颈骨折均有显著的临床效果,但对于手术耐受性好者应优先选择半髋关节置换术治疗。

Objective To evaluate the clinical efficacy of hemiarthroplasty and cannulated compression screw fixation in the treatment of osteoporotic femoral neck fractures in elderly patients. Methods 96 cases of elderly patients with osteoporotic femoral neck were collected. According to the different type of Garden,they were randomly divided into semi - hip arthroplasty group（48 cases） and cannulated screw fixation group（48 cases）. The operation time,intraoperative blood loss, postoperative bedridden time and other general conditions of the two groups were observed. The postoperative complications were observed. The changes of Harris score of hip joint were observed and evaluated. Results The amount of bleeding （ 236.72±15.88） ml and operation time（ 1.99 ± 0.41 ） h of semi - hip replacement patients were higher than that of cannulated screw fixation group （0.91±0.39 ） h and （ 88.75 ± 15.85 ） ml. The difference was statistically significant （ P 〈 0.05 ）. However, the postoperative bedridden time of the half hip arthroplasty patients were lower than the cannulated screw fixation group [ （ 13.59±3.41 ） d vs （40.72±3.38 ） d ,P 〈 0.05 ） ]. The excellent rate of hip replacement patients was 95.45% ,the excellent rate of screw fixation group were cannulated for 81.82% ,the difference was statistically significant （P 〈 0.05 ）. Cortelusions Semi hip arthroplasty and cannulated compression screw fixation for osteoporotie femoral neck fractures in elderly patients have significant clinical effect, but the patients with good tolerance should be preferentially given to the treatment of hemiarthroplasty.