全髋关节置换术治疗老年移位型股骨颈骨折的临床研究

Clinical research of total hip arthroplasty in treating displacement type transcervical fracture of senile patients

目的探讨全髋关节置换术(total hip arthroplasty,THA)治疗老年移位型股骨颈骨折(displacement type transcervical fracture,DTTF)的临床疗效。方法 2014年1月—2016年12月成都医学院第一附属医院骨外科治疗DTTF患者136例,其中男性50例,女性86例;年龄63~82岁,平均70.45岁;致伤因素:道路交通伤28例,摔伤84例,坠落伤18例,其他6例。依据随机数字表法分为THA组(n=68)与空心钉内固定组(hollow nail internal fixation,HNIF,n=68)。观察两组术中出血量、手术时间、治疗费用、住院时间等手术相关指标,术后1个月、1年髋关节功能评分,生存质量及日常生活能力,术后并发症等指标。结果 THA组术中出血量(311.86±31.34)m L、手术时间(85.68±8.64)min、输血量(364.63±36.47)m L、术后1d视觉模拟评分(VAS)(5.74±0.58)分、治疗费用(4.60±0.48)万元,均多于HNIF组[术中出血量(141.63±14.22)m L、手术时间(62.86±6.30)min、输血量(182.87±18.42)m L、术后1d VAS评分(4.63±0.47)分、治疗费用(2.74±0.28)万元];THA组住院时间(17.32±1.74)d,少于HNIF组(22.51±2.31)d,差异有统计学意义(P<0.05)。术后1个月,两组髋关节功能、生存质量及日常生活能力评分无差异(P>0.05);术后1年,两组髋关节功能、生存质量及日常生活能力评分均较术后1个月增大,THA组髋关节功能、生存质量及日常生活能力评分大于HNIF组(P<0.05)。THA组术后1年优良率(82.35%)高于HNIF组(48.53%,P<0.05)。THA组术后并发症发病率(2.94%)低于HNIF组(29.41%),差异有统计学意义(P<0.05)。结论 THA治疗老年DTTF可改善患者髋关节功能,提高生存质量及日常生活能力,术后并发症少,可应用于临床。

Objective To study the clinical efficacy of total hip arthroplasty （THA） in treating displacement type transcervical fracture （DTTF）. Methods A total of 136 DTTF patients treated in bone surgery department of our hospital from Jan. 2014 to Dec. 2016 were selected,and divided into THA group （n=68） and control group （n=68） using random number table method. Among them were 50 males and 86 females with an average of 70.45（63-82） years. Twenty-eight patients were injured from road traffic accidents,84 were from falling,18 were from high falling and 6 were from other causes. Patients in control group were performed hollow nail internal fixation （HNIF）,and those in THA group were performed THA treatment. The intraoperative blood loss,operation time,treatment cost,hospitalization time and other surgery related indicators,and the scores of hip joint function,the quality of life,the activity of daily living and postoperative complications at 1 month and 1 year after operation in the two groups were observed. Results The intraoperative blood loss,operation time,blood transfusion volume,VAS score at 1d after operation and treatment cost in the THA group were more than those in the control group,hospitalization time was less than that of the control group（ P 〈0.05）. At 1 month after operation,there was no difference in the scores of hip joint function,quality of life and activity of daily living between the two groups （ P 〉0.05）. At 1 year after operation,the scores of hip joint function,quality of life and activity of daily living in the two groups were higher than those at 1 month after operation, the scores of hip joint function,quality of life and activity of daily living in the THA group were higher than those in the control group （ P 〈 0.05）. The excellent rate at 1 year after operation in the THA group （82.35%） was higher than that in the control group （48.53%, P 〉0.05）. The incidence of postoperative complications in the THA group （2.94%） was lower than that in the control group （29.41%, P 〈 0.05）. Conclusion THA for treating senile patients with DTTF can improve hip joint function and enhance quality of life and activity of daily living,and has fewer postoperative complications,so it can be applied to clinical practice.