比较后外侧入路下两种术式治疗老年股骨颈骨折脱位率

Comparison of dislocation rate between two diffcrent surgical methods in treatment of senile femoral neck fracture by posterolateral approaches

目的对比分析后外侧入路下全髋关节置换(THA)与人工双极股骨头置换(BHA)治疗老年股骨颈骨折患者的脱位率。方法回顾性分析2018年1月至2020年1月福建中医药大学附属泉州市正骨医院关节科收治的347例并获得至少1年以上随访的股骨颈骨折患者,秩和检验、t检验等方法对比两组脱位患者与未脱位患者间性别、年龄、髋关节预防措施依从性及年龄与调查问卷得分相关性等信息。结果术后1年内共有10例患者出现脱位,BHA者脱位率5.7%(7例)较THA者脱位率1.3%(3例)高(P=0.026);脱位组患者的年龄较非脱位组大(t=2.318,P<0.05);髋关节预防措施依从性调查问卷显示,BHA组患者得分(76±16),较THA组患者(83±11)低(U=10038,P<0.05);在BHA和THA两组中,发生脱位患者的得分[BHA组(56±14),THA组(62±9)]低于未发生脱位患者[BHA组(76±16),THA组(84±9)](F=34.25,P<0.05);而年龄因素与髋关节预防措施依从性调查问卷得分呈负相关(R2=0.79,P<0.05),回归方程为Y=-0.6523x+125.7。结论良好的髋关节脱位预防措施依从性是预防脱位的重要因素,为临床医生重视及按计划指导患者髋关节脱位预防措施提供了一定的理论基础。

Objective To compare and analyze the dislocation rate of total hip replacement(THA)and artificial bipolar femoral head replacement(BHA)under the posterolateral approach for the treatment of elderly patients with femoral neck fractures.Methods A retrospective analysis of 347 patients with femoral neck fractures who were admitted to the Department of Arthritis,Quanzhou Orthopedic Hospital Affiliated to Fujian University of Traditional Chinese Medicine from January 2018 to January 2020 and had been followed up for at least one year,was performed.Information about gender,age,body mass index(BMI),time from fracture to operation,compliance with hip joint preventive measures,and correlation between age and questionnaire scores were compared between the two groups of dislocated and non-dislocated patients,by rank sum test and t test.Results A total of 10 patients had dislocation within one year after the operation.The dislocation rate of BHA patients was 5.7%,which was higher than that of THA patients(1.3%)(P=0.026).The age of the dislocation group was elder than the non-dislocation group(t=2.318,P<0.05).As for the hip joint preventive measures compliance questionnaire score,the BHA group(76±16)was lower than the THA group(83±11)(U=10038,P<0.05).In the BHA and THA groups,while the score of the patients with dislocations[the BHA group(56±14),the THA group(62±9)]showed lower scores than those without dislocations[BHA group(76±16),THA group(84±9)](F=34.25,P<0.05);while the age factor was negatively correlated with the hip joint preventive measures compliance questionnaire score(R2=0.79,P<0.05).The regression equation was Y=-0.6523x+125.7.Conclusion Good compliance with hip dislocation prevention measures is an important factor in preventing dislocation,which may provide a certain theoretical basis for clinicians to pay attention and guide patients preventing hip dislocation as planned.