人工全髋关节置换术与采用空心加压螺纹钉内固定术治疗老年股骨颈骨折的效果比较

Comparison on effects of artificial total hip replacement and hollow compression screw internal fixation in the treatment of elderly femoral neck fractures

目的比较人工全髋关节置换术与采用空心加压螺纹钉内固定术治疗老年股骨颈骨折的效果。方法 80例老年股骨颈骨折患者,按照手术方式的不同将其分为关节置换组(42例)和内固定组(38例)。关节置换组患者采用人工全髋关节置换术治疗;内固定组患者采用空心加压螺纹钉内固定术治疗。比较两组患者术后卧床时间、住院费用、手术时间和手术输血量,记录两组患者术后3、6、12个月Harris髋关节功能评分,分析两组患者术后1年并发症发生情况。结果关节置换组手术时间为(95.37±21.18)h,明显长于内固定组的(68.28±16.51)h;手术输血量为(560.48±43.53)ml,明显多于内固定组的(100.73±17.84)ml;术后卧床时间为(3.87±0.27)d,明显短于内固定组的(42.45±5.23)d;住院费用为(35758.89±7692.98)元,明显高于内固定组的(13276.23±2007.78)元;差异均有统计学意义(P<0.05)。关节置换组患者术后3、6个月Harris髋关节功能评分均高于内固定组,差异有统计学意义(P<0.05);两组患者术后12个月Harris髋关节功能评分比较差异无统计学意义(P>0.05)。术后随访1年,关节置换组患者并发症发生率为7.1%,明显低于内固定组的23.7%,差异有统计学意义(P<0.05)。结论对于老年股骨颈骨折患者,人工全髋关节置换术与空心加压螺纹钉内固定术各有优势,应根据患者的客观具体情况以及主观需求进而采用不同的术式,同时完善围手术期全面评估及治疗能最大程度地提高患者髋关节功能,改善预后,减少术后并发症的发生。

Objective To compare the effect of artificial total hip replacement and hollow compression screw internal fixation in the treatment of elderly femoral neck fractures.Methods A total of 80 elderly patients with femoral neck fractures were divided by different surgical methods into hip replacement group（42 cases） and internal fixation group（38 cases）.Hip replacement group was treated with artificial total hip replacement,and internal fixation group was treated with hollow compression screw internal fixation.Comparison were made on postoperative bedtime,hospitalization costs,operative time and surgical blood transfusion volume,and record were made on Harris hip function score in postoperative 3,6 12 months.The occurrence of complications in postoperative 1 year between two groups was analyzed.Results Hip replacement group had obviously longer operation time as（95.37±21.18）h than（68.28±16.51）h in internal fixation group,obviously more surgical blood transfusion volume as（560.48±43.53）ml than（100.73±17.84）ml in internal fixation group,obviously shorter postoperative bedtime as（3.87±0.27）d than（42.45±5.23）d in internal fixation group,and obviously higher hospitalization costs as（35758.89±7692.98）yuan than（13276.23±2007.78）yuan in internal fixation group.Their difference was statistically significant（P〈0.05）.Hip replacement group had higher Harris hip function score in postoperative 3,6 months than internal fixation group,and the difference was statistically significant（P〈0.05）.Both groups had no statistically significant difference in Harris hip function score in postoperative12 months（P〉0.05）.In 1 year of follow-up after operation,hip replacement group had obviously lower incidence of complications as 7.1% than 23.7% in internal fixation group,and the difference was statistically significant（P〈0.05）.Conclusion For elderly patients with femoral neck fracture,both artificial total hip arthroplasty and hollow compression screw internal fixation have its advantages.Different surgical modes should be selected according to objective conditions and subjective needs.Perfect perioperative comprehensive assessment and treatment can maximally improve the patient＇s hip function,improve their prognosis and reduce the incidence of postoperative complications.