人工髋关节置换和空心钉内固定治疗高龄患者股骨颈骨折的临床疗效对比

Comparison of clinical effects of total artificial hip replacement and cannulated screw fixation for the treatment of displaced femoral neck fractures in elderly patients

目的 :研究比较不同的手术方法治疗高龄股骨颈骨折的临床疗效。方法 :选择自2013年1月至2016年6月收治高龄股骨颈患者144例,根据手术方式分为人工髋关节置换组(关节置换组)和空心钉内固定组(内固定组)。其中关节置换组89例,男28例,女61例,平均年龄(84.10±3.10)岁;内固定组55例,男20例,女35例,平均年龄(86.80±2.88)岁。比较两组患者术前基本资料、术后并发症、死亡率及术后髋关节Harris评分等。结果 :144例术后均获得完整随访,随访时间12~36个月,平均18个月。两组患者在性别、骨折侧别、术前合并症、骨质疏松、ASA评分、受伤至手术时间、术后转ICU人数、围手术期死亡人数上差异不明显。但是内固定组较关节置换组年龄更大(t=5.311,P<0.05);关节置换组术前骨折移位程度高于内固定组(χ~2=6.894,P=0.009<0.05);内固定组在手术时间、住院时间、术中出血量、围手术期输血人次上明显优于关节置换组(P<0.05);关节置换组在术后Harris评分高于内固定组(P<0.05)。结论:对于高龄股骨颈患者,若骨折存在明显移位(GardenⅢ、Ⅳ型),首选人工髋关节置换,其术后并发症相对较少,关节功能恢复满意。若骨折移位不明显(GardenⅠ、Ⅱ型)或患者合并较多内科疾病,身体条件较差,手术耐受差,术后预期寿命不高,首选闭合复位空心钉内固定。

Objective：To compare of clinical effects of different surgical methods in the treatment of elderly femoral neck fractures. Methods：From January 2013 to June 2016,144 elderly patients with femoral neck were treated and divided into artificial hip replacement group and cannulated screw fixation group according to the surgical methods. In the total hip arthroplasty group,there were 89 cases,28 males and 61 females,with an average age of（84.10±3.10） years old;Hollow nail fixation group 55 cases,20 males and 35 females,with an average age of（86.80±2.88） years. Preoperative patients data,postoperative complications,mortality and postoperative Harris hip score were compared between the two groups. Result：A total of 144 cases were followed up for 12 to 36 months with an average of 18 months. There was no significant difference between two groups in gender,fracture side,preoperative complications,osteoporosis,ASA score,injury to surgery interval,the number of patients admitted to ICU and perioperative death. However,the patients in hollow screw fixation group was older than the joint replacement group（t=5.311,P〈0.05）;The degree of preoperative fracture displacement in the joint replacement group was higher than that in the hollow nail fixation group（χ~2=6.894,P=0.0090.05）;Hollow nail fixation group in operation time,hospital stay,intraoperative blood loss,perioperative blood transfusion was significantly better than the number of joint replacement group（P〈0.05）;The Harris score of the joint replacement group was higher than that of the hollow screw fixation group（P〈0.05）. Conclusion：For elderly femoral neck patients,if there is a significant shift in the fracture（Garden Ⅲ,Ⅳ）,the preferred treatment is hip replacement. Postoperative complications are relatively small,satisfactory joint function recovery. If the fracture displacement is not obvious（Garden typeⅠ, Ⅱ） or patients with more medical diseases,poor physical condition,poor surgical tolerance,postoperative life expectancy is not high,the first choice is closed reduction and cannulated screw fixation.