不同手术方法治疗老年移位性股骨颈骨折患者的效果观察

Clinical efficacy of different surgical methods for treatment of displaced femoral neck fracture in elderly patients

目的 探讨内固定术（IF）和髋关节置换术（HA）治疗老年移位性股骨颈骨折的效果.方法 选择我院2010年1月至2015年1月收治的63例老年移位性股骨颈骨折患者的临床资料,将患者按治疗方法的不同分为IF组（33例）和HA组（30例）.IF组患者采用内固定术,HA组患者采用HA.观察两组患者手术时间、术中出血量、住院时间、术后并发症及再手术率.采用Harris评分评定患者髋关节功能,并对术后1、2年两组患者髋关节功能进行比较.结果 IF 组和 HA 组患者手术时间[（0.8 ±0.3）、（1.7±0.2）h]、术中出血量[（110.9±9.9）、（587.2±35.7）ml]、住院时间[（16.4±2.0）、（24.8 ±3.7）d]比较差异均有统计学意义（P值分别为0.041、0.000、0.038）.IF组患者术后远期并发症发生率为27.3%（9/33）、再手术率为24.2%（8/33）,HA组分别为10.0%（3/30）、6.7（2/30）,两组患者比较差异均有统计学意义（P值分别为0.045、0.039）.HA 组患者术后1、2年髋关节功能优良率分别为83.3%、80.0%,IF组分别为63.6%、57.6%,两组比较差异均有统计学意义（P值分别为0.043、0.042）.结论 内固定术和HA治疗老年移位性股骨颈骨折效果各有优劣,内固定术具有对患者创伤较小、术中失血少、机体恢复快等优点,但术后远期并发症和再手术率均高于HA.HA治疗老年股骨颈骨折远期效果优于内固定术,值得临床推广.

Objective To investigate the clinical effect of internal fixation（IF）and total hip replacement（HA）for treatment of displaced femoral neck fracture in elderly patients.Methods Sixty-three cases with femoral neck fracture hospitalized in Chaoyang Central Hospital from January 2010 to January 2015 were selected as research subjects and were divided into IF group（33 cases）and HA group（30 cases） according to the different treatment methods.The patients in IF group were treated with internal fixation and the patients in HA group were treated with hip replacement.The duration of operation,intraoperative blood loss, length of hospital stay,incidence of postoperative complication and reoperation rate in both groups were recorded.The hip function was evaluated by Harris score,and the hip function of the two groups was compared in 1 year,2 years after operation.Results Compared with HA group,the patients in IF group had shorter operation time,less intraoperative blood loss and shorter hospitalization time（（0.8± 0.3）h vs.（1.7± 0.2）h;（110.9 ±9.9）ml vs.（587.2±35.7）ml;（16.4±2.0）d vs.（24.8±3.7）d）,the differences among the two groups were statistically significant（P=0.041,0.000,0.038）.Th incidence of long term postoperative complication was 27.3%（9/33）in IF group and was 10.0%（3/30）in HA group.The reoperation rate was 24.2%（8/33）in IF group and was 6.7%（2/30）in HA group.The differences between the two groups were statistically significant （P=0.045,0.039）.The excellent and good rates of hip joint function in HA group after 1 and 2 years after operation were 83.3% and 80.0%,and 63.6% and 57.6% in IF group in 1 and 2 years after operation respectively.The differences between the two groups were statistically significant（P = 0.043,0.042） .Conclusion Internal fixation and hip replacement in the treatment of displaced femoral neck fractures in the elderly effect have their own advantages and disadvantages.Internal fixation has the advantages of less trauma, less blood loss and rapid recovery,but the long-term complications and reoperation rates are higher than those in HA.The long-term clinical effect of HA for the treatment of femoral neck fracture in elderly patients is better than that of internal fixation and it is worthy of clinical promotion.