闭合复位空心钉内固定与全髋关节置换术在移位型股骨颈骨折老年患者中的应用效果对比

Comparison of the effect of closed reduction cannulated screw internal fixation and total hip arthroplasty in elderly patients with displaced femoral neck fracture

目的比较闭合复位空心钉内固定(IF)与全髋关节置换术(THA)在移位型股骨颈骨折老年患者中的应用效果。方法回顾性选取2012年3月至2017年5月60例在我院接受移位型股骨颈骨折的老年患者为研究对象,按照治疗方法分为IF组(27例)和THA组(33例),比较患者的手术相关指标、生活质量、疼痛度、手术并发症及髋关节功能改良评分。结果 IF组手术时间为(41.36±3.24)min、术中出血量(47.10±9.48)ml、住院时间(7.29±2.31)d、输血量(312.42±26.38)ml、住院费用(34 290.13±2 758.68)元,THA组手术时间(89.53±7.37)min、术中出血量(247.65±31.56)ml、住院时间(15.07±4.26)d、输血量(517.65±43.54)ml、住院费用(37 947.24±3 211.52)元,THA组均高于IF组(P<0.05);治疗后THA组KPS评分为(81.60±5.58)分高于IF组,Mc Gill评分为(32.47±4.52)分低于IF组(P<0.05);治疗后12个月和18个月THA组髋关节功能改良评分高于IF组(P<0.05)。THA并发症发生率为18.18%,IF组为40.74%,THA组低于IF组,差异具有统计学意义(P<0.05)。结论闭合复位空心钉内固定与全髋关节置换术均能有效治疗移位型股骨颈骨折,THA虽然费用高,创伤面大,但是并发症少,患者经受痛苦小,生活质量得到明显提高。

Objective To compare the effect of closed reduction hollow screw internal fixation（ IF） and total hip arthroplasty（ THA） in elderly patients with displaced femoral neck fracture. Methods A total of 60 elderly patients with displaced femoral neck fractures in our hospital from March 2012 to May 2017 were selected and divided into two groups according to the treatment： IF group（ 27 cases） and THA group（ 33 cases）. Patients＇ surgeries,quality of life,pain scores,surgical complications,and hip function improvement scores were compared. Results The operation time of IF group was（ 41. 36 ± 3. 24） min,blood loss was（ 47. 10 ± 9. 48） ml,hospitalization time was（ 7. 29 ± 2. 31） d,blood transfusion volume was（ 312. 42 ± 26. 38） ml and hospitalization expense was（ 34 290. 13 ± 2 758. 68） yuan. The mean duration of operation（ 89. 53± 7. 37） min,intraoperative blood loss（ 247. 65 ± 31. 56） ml,hospital stay（ 15. 07 ± 4. 26） days,blood transfusion volume（ 517. 65 ± 43. 54）ml and hospitalization cost（ 37 947. 24 ± 3 211. 52）（ P〈0. 05）. The KPS score of THA group（ 81. 60 ± 5. 58） was higher than that of IF group,and Mc Gill score（ 32. 47 ± 4. 52） was lower than that of IF group（ P〈0. 05）. The improvement of hip function in THA group was higher than that of IF group at 12 months and 18 months after treatment,the incidence of THA complication was 18. 18%,which was lower than that of IF group 40. 74%,the difference was statistically significant（ P〈0. 05）. Conclusion Closed reduction hollow screw internal fixation and total hip arthroplasty are effective in treating displaced femoral neck fracture. Although THA is costly and has a large trauma surface,the complications are less and the quality of life of patients suffering from pain is significantly improved.