全髋关节置换术治疗老年股骨颈骨折的疗效观察

Total hip replacement of in treatment of elderly patients with displaced transcervical fracture

目的 探讨全髋关节置换术治疗老年股骨颈骨折的疗效.方法 选取本院2014年1月至2017年5月收治的105例老年移位型股骨颈骨折患者进行研究,按随机数字表法将其分为研究组54例与对照组51例.对照组患者采用骨折内固定术治疗,研究组采用全髋关节置换术治疗.治疗后,两组患者手术相关指标、日常生活能力（ADL）、世界卫生组织生存质量测定量表（WHO-QOL）、髋关节功能（Harris评分）及近远期并发症发生情况比较.结果 研究组患者手术时间、卧床时间、住院时间较对照组长,住院费用及术中出血量高于对照组,差异有统计学意义（均P＜ 0.05）.术后1个月时,两组患者Harris评分、ADL评分及WHO-QOL评分比较,差异无统计学意义（均P＞0.05）.术后12个月时,研究组患者Harris评分、ADL评分及WHO-QOL评分均高于对照组患者,差异有统计学意义（均P＜0.05）.术后1个月时,研究组共发生并发症10例（18.52％）,对照组共发生并发症11例（21.57％）,近期并发症发生率比较,差异无统计学意义（x 2=0.153,P＞ 0.05）.术后12个月时,对照组发生骨不连5例（9.80％）,股骨头缺血坏死4例（7.84％）,研究组无并发症发生,对照组远期并发症发生率高于研究组,差异有统计学意义（x 2=10.423,P＜0.05）.结论 全髋关节置换术治疗老年移位型股骨颈骨折远期疗效及安全性较好.

Objective To investigate the effect of total hip replacement in the treatment of elderly patients with displaced transcervical fracture.Methods 105 elderly patients with displaced transcervical fracture treated at our hospital from January,2014 to May,2017 were chosen as experimental subjects,and were divided into a control group and a research group.The control group were treated with internal fixation of fracture,and the research group with total hip replacement.After the treatment,the operation related indicators,activities of daily living （ADL）,WHO quality of life scale （WHO-QOL）,hip joint function （Hams score）,and short-term and longterm complications were compared between the two groups.Results The operation time,bed time,and length of stay were longer and the hospitalization cost of and intraoperative bleeding volume were higher in the research group than in the control group,with statistical differences （all P〈0.05）.There were no statistical differences in Harris score,ADL score,and WHO-QOL score between the two groups 1 months after the operation （all P〉0.05）.The Harris score,ADL score,and WHO-QOL score were higher in the research group than in the control group 12 months after the operation,with statistical differences （all P〈0.05）.1 months after the operation,10 cases （18.51%） had complications in the research group,and 11 cases （21.56%） in the control group.There was no statistical difference in the incidence of short-term complications between these two groups （x 2=0.153,P〉0.05）.12 months after operation,5 cases （9.80%） had bone nonunion and 4 cases （7.84%） got avascular necrosis of the femoral head in the control group,and no complication occurred in the research group;the incidence of longterm complications was higher in the control group than in the research group （x 2=10.423,P〈0.05）.Conclusion Total hip replacement in the treatment of elderly patients with displaced transcervical fracture has good long-term effect and safety.