老年股骨颈骨折左心衰竭半髋与全髋置换比较

Hemiarthroplasty versus total hip arthroplasty for femoral neck fracture accompanied with left heart failure in the elderly

[目的]比较老年股骨颈骨折合并左心哀竭患者行半髋置换(hemiarthroplasty,HA)与全髋置换(total hip arthroplasty,THA)的临床疗效。[方法]回顾性分析本院2017年-2019年有移位股骨颈骨折合并左心衰竭的45例老年患者的临床资料。依据术前医患沟通和心功能状态将患者分为两组,其中,30例行HA,15例行THA。比较两组临床、心功能及影像资料。[结果]两组均顺利完成手术,HA组手术用时、术中出血量、术后引流量、血色素下降值以及住院用时均显著优于THA组(P<0.05)。随时间推移,两组患者Harris评分均显著增加(P<0.05)。术后3、6个月两组Harris评分的差异无统计学意义(P>0.05),术后12个月THA组的Hairis评分显著优于HA组(P<0.05)。心功能方面,手术前后两组患者射血分数均无显著变化(P>0.05)。术前、术后3d和末次随访时,HA组的射血分数均显著低于THA组(P<0.05)。术后影像显示,两组患者假体位置良好,未见假体周围透亮带,无骨溶解、感染、下沉等表现。[结论]心衰且射血分数异常患者可考虑选择半髋置换,其安全性及效果肯定。心衰但射血分数正常患者可考虑选择全髓置换,具有更好的远期髋关节功能疗效。

[Objective]To compare the clinical efficacy of hemiarthroplasty(HA)versus total hip arthroplasty(THA)for femoral neck fracture accompanied with left heart failure in the elderly.[Methods]A retrospective study was conducted on 45 elderly patients who received surgical treatment for displaced femoral neck fracture complicated with left heart failure in our hospital from 2017 to 2019.According to preoperative doctor-patient communication and cardiac function status,30 patients underwent HA,while the remaining 15 patients underwent THA.The documents regarding to clinical conditions,cardiac function and radiographs were compared between the two groups.[Results]The HA group proved significantly superior to the THA group in terms of operation time,intraoperative blood loss,postoperative drainage,decline of hemoglobin and hospital stay(P<0.05).The Harris scores increased significantly over time postoperatively in both groups(P<0.05).Although there were no significant differences in Harris score between the two groups at 3 and 6 months after surgery(P>0.05),the THA group was significantly better than HA group in Harris score at 12 months after operation(P<0.05).In terms of cardiac function,the ejection fraction remained unchanged before and after surgery in both groups(P>0.05),whereas which in the HA group were significantly inferior to those in the THA group at any corresponding time point(P<0.05).Postoperative radiographs showed that the prosthesis in both groups was in good position,without clear band around the prosthesis,osteolysis,infection,subsidence and other adverse manifestations.[Conclusion]Hemiarthroplasty is safe and effective for the patients with heart failure and abnormal ejection fraction,whereas to-tal hip arthroplasty should be considered for those with heart failure but normal ejection fraction to achieve better long-term hip function.