人工股骨头置换术与全髋关节置换术治疗老年股骨颈骨折患者的效果比较

Comparison of effects of artificial femoral head replacement and total hip arthroplasty in treatment of elderly patients with femoral neck fractures

目的:比较人工股骨头置换术与全髋关节置换术治疗老年股骨颈骨折患者的效果。方法:回顾性分析2019年1—9月该院收治的90例老年股骨颈骨折患者的临床资料,根据手术方案不同分为对照组和观察组各45例。对照组采用人工股骨头置换术治疗,观察组采用全髋关节置换术治疗,比较两组手术相关指标(手术时间、术中出血量、住院时间和医疗费用)水平,术后并发症发生率和术后6个月、术后2年髋关节功能优良率。结果:观察组手术时间和住院时间均长于对照组,术中出血量和医疗费用均多于对照组,差异有统计学意义(P<0.05);两组切口感染、深静脉血栓发生率比较,差异均无统计学意义(P>0.05);观察组髋臼磨损、假体松动发生率均低于对照组,差异有统计学意义(P<0.05);两组术后6个月髋关节功能优良率比较,差异无统计学意义(P>0.05);观察组术后2年髋关节功能优良率高于对照组,差异有统计学意义(P<0.05)。结论:相较人工股骨头置换术,全髋关节置换术治疗老年股骨颈骨折患者可提高术后2年髋关节功能优良率,降低髋臼磨损、假体松动发生率,但其手术时间和住院时间长,术中出血量多,且医疗费用高。

Objective:To compare effects of artificial femoral head replacement and total hip arthroplasty in treatment of elderly patients with femoral neck fractures.Methods:A retrospective analysis of the clinical data of 90 elderly patients with femoral neck fractures admitted to the hospital from January 2019 to August 2020 was performed.According to different surgical plans,they were divided into control group and observation group,each with 45 cases.The control group was treated with artificial femoral head replacement,while the observation group was treated with total hip arthroplasty.The surgery-related indicator levels[operation time,intraoperative blood loss,hospitalization time and medical expenses],the incidence of postoperative complications and the excellent and good rate of hip function 6 months and 2 years after the surgery were compared between the two groups.Results:The operation time and the hospitalization time of the observation group were longer than those of the control group;the intraoperative blood loss and the medical expenses were higher than those of the control group;and the differences were statistically different(P<0.05).There were no significant differences in the incidence of incision infection and the deep vein thrombosis between the two groups(P>0.05).The incidence rates of acetabular wear and prosthesis loosening in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the excellent and good rate of hip function between the two groups 6 months after the surgery(P>0.05).However,the excellent and good rate of hip function in the observation group was higher than that in the control group 2 years after the surgery,and the difference was statistically significant(P<0.05).Conclusions:Compared with artificial femoral head replacement,total hip arthroplasty in the treatment of the elderly patients with femoral neck fractures can increase the excellent and good rate of hip function 2 years after the surgery,reduce the incidence rates of acetabular wear and prosthesis loosening;however,it has longer operation time and hospitalization time,heavy intraoperative blood loss,and high medical expenses.