早期快速闭合复位空心钉内固定治疗高龄股骨颈骨折的临床研究

Clinical results of early and rapid close reduction with internal fixation cannulated screws for femoral neck fractures in elderly patients

目的探讨内科和麻醉科多学科协作下早期快速(48 h内)闭合复位空心钉内固定治疗伴有内科合并症的高龄(>75岁)股骨颈骨折患者的临床疗效。方法回顾性分析北京积水潭医院2014年1月至2014年6月收治的符合纳入排除标准的高龄股骨颈骨折患者48例。其中26例拟行早期快速(48 h内)闭合复位空心钉内固定手术(早期快速手术组),22例拟行闭合复位空心钉内固定手术(常规手术组,7例因准备期间内科基础疾病加重行保守治疗)。比较两组患者的术前等待时间、手术率、术中出血量、围手术期输血量、手术时间、术后生存率、骨折愈合率、住院时间、住院费用及日常生活功能恢复量表(FRS)评分。结果早期快速手术组无失访,随访率100%。常规手术组4例死亡,随访率81.8%。随访时间为12~18个月。组间手术时间、术中出血量、骨折愈合率比较差异无统计学意义。与常规手术组相比,早期快速手术组患者的住院时间、术前等待时间较短,手术率及1年生存率较高,医疗费用较低,差异均有统计学意义(t=-9.412,P<0.001;t=-17.531,P<0.001x^2=9.685,P<0.05;x^2=5.157,P<0.05;t=-2.203,P<0.05);骨折前两组患者的FRS评分无统计学差异,治疗后早期快速手术组高于常规手术组,差异具有统计学意义(t=2.225,P<0.05)。结论早期快速(48 h内)闭合复位空心钉内固定治疗合并内科基础疾病的高龄(>75岁)股骨颈骨折患者可缩短住院及待术时间、降低住院费用、提高患者生存率并有效促进髋关节功能恢复。

Objective To observe and investigate the clinical effects of early (within 48 hours) and rapid close reduction and internal fixation with cannulated screws for femoral neck fractures in elderly patients (>75 years) with multiple chronic systemic diseases. Methods A retrospective study were performed in 48 eligible femoral neck fractures (over 75 years old) with multiple chronic systemic diseases in Beijing Jishuitan Hospital from January 2014 to June 2014. Twenty-eight patients underwent cannulated screws internal fixation within 48 h were included into early and rapid treatment group, the rest 22 patients were included in the routine treatment group (normal cannulated screws internal fixation), among them, 7 patients took conservative treatment considering the deterioration of heart and lung. The preoperative waiting time, surgical rate, blood loss, perioperative transfusion, surgical time, postoperative survival incidence,fracture healing rate, hospital stay, medical costs and functional recovery scale were followed up periodically and compared between two groups. Results All patients received successful follow-up in early and rapid treatment group (100%), 4 patients were died and patient retention was 81.8%. Others followed-up for 12 to 18 months. Both group had similar operation time, blood loss and healing rate of femoral neck fractures, no statistically significant differences were observed. Early and rapid treatment group presented shorter hospitalization stay, shorter preoperation waiting time, higher surgical rate, higher one- year survival rate,lower medical costs than routine treatment group, differences were statistically significant (t=- 9.413,P<0.001; t=- 17.531, P<0.001; c2=9.685, P<0.05; c2=5.157, P<0.05; t=- 2.203, P<0.05). Meanwhile early and rapid treatment group showed higher FRS score than routine treatment group, differences were statistically significant (t=2.225, P<0.05), even though the base line of FRS had no significant difference between two groups. Conclusion Early and rapid close reduction with cannulated screws internal fixation within 48 hours can achieve better clinical results in the treatment of elderly femoral neck fractures (>75 years)with multiple chronic systemic diseases, patients had shorter hospitalization stay, better hip joint function (FRS), less medical costs and better survival rate, this method especially suit elderly patients (>75 years) associated with multiple chronic systemic diseases.