髋关节置换术治疗老年移位型股骨颈骨折的临床效果

Clinical effect of hip replacement in the treatment of displaced femoral neck fracture in the elderly

目的探讨髋关节置换术治疗老年移位型股骨颈骨折的临床效果。方法回顾性选取2015年3月至2019年2月本院190例老年移位型股骨颈骨折患者,依据手术方法将其分为常规内固定术组(常规内固定术)和髋关节置换术组(髋关节置换术),各95例。比较两组的手术相关指标、髋关节功能、术后并发症发生情况、疼痛程度、心理状态及治疗依从性。结果髋关节置换术组的术中切口长度、手术时间显著长于常规内固定术组,术中出血量、术中输血量显著多于常规内固定术组,术后下床时间、住院时间显著短于常规内固定术组,差异具有统计学意义(P<0.05)。术后,两组的Harris评分均升高,且髋关节置换术组显著高于常规内固定术组,差异具有统计学意义(P<0.05)。髋关节置换术组的术后并发症总发生率为15.79%,显著低于常规内固定术组的41.05%,差异具有统计学意义(P<0.05)。术后,两组的VAS、焦虑、抑郁评分均降低,治疗依从性评分均升高,且髋关节置换术组优于常规内固定术组,差异具有统计学意义(P<0.05)。结论髋关节置换术与常规内固定术治疗老年移位型股骨颈骨折各具优劣势,髋关节置换术在改善患者髋关节功能及心理状态、降低术后并发生发生率、减轻疼痛、提高治疗依从性方面效果更佳。

Objective To investigate the clinical effect of hip replacement in the treatment of displaced femoral neck fracture in the elderly.Methods A total of 190 elderly patients with displaced femoral neck fracture in our hospital from March 2015 to February 2019 were retrospectively selected and divided into routine internal fixation group(routine internal fixation)and hip replacement group(hip replacement)according to the surgical method,with 95 cases in each group.The operation related indexes,hip joint function,postoperative complications,degree of pain,psychological state and treatment compliance were compared between the two groups.Results The length of incision and operation duration in the hip replacement group were significantly longer than those in the routine internal fixation group,the intraoperative bleeding and intraoperative blood transfusion were significantly more than those in the routine internal fixation group,the postoperative out-of-bed time and hospital stay were significantly shorter than those in the routine internal fixation group,and the differences were statistically significant(P<0.05).After operation,the Harris score of the two groups increased,and that in the hip replacement group was significantly higher than that in the routine internal fixation group,and the difference was statistically significant(P<0.05).The total incidence of postoperative complications in the hip replacement group was 15.79%,which was significantly lower than 41.05%in the routine internal fixation group,and the difference was statistically significant(P<0.05).After operation,the VAS,anxiety and depression scores of the two groups decreased,the treatment compliance score increased,those in the hip replacement group were better than the routine internal fixation group,and the differences were statistically significant(P<0.05).Conclusion Hip replacement and routine internal fixation in the treatment of displaced femoral neck fractures in the elderly have their own advantages and disadvantages.Hip arthroplasty has a better effect in ameliorating hip joint function and psychological state,decreasing postoperative complications,reducing pain and improving treatment compliance.