内固定术与人工髋关节置换术治疗老年髋部骨折患者的临床效果

Clinical Efficacy of Internal Fixation and Joint Replacement in the Treatment of Elderly Patients with Hip Fracture

目的研究内固定术与人工髋关节置换术治疗老年髋部骨折患者的临床效果。方法将2017年8月至2018年10月于我院经手术治疗的老年髋部骨折114例按照手术方式的不同分为内固定组(78例)与关节置换组(36例)。比较两组的手术情况、Harris评分、术后谵妄情况。结果关节置换组术中出血量、手术时间、术后引流量、术后负重时间分别为(171.49±9.64)mL、(78.15±10.62)min、(83.64±13.43)mL、(8.17±1.55)d,与内固定组的(314.54±10.96)mL、(89.46±11.33)min、(108.46±15.94)mL、(29.43±3.42)d比较,差异有统计学意义(P<0.05);术后6、12个月,关节置换组Harris评分分别为(85.46±6.33)、(85.91±5.20)分,显著高于内固定组的(71.46±8.21)、(70.94±7.26)分,差异有统计学意义(P<0.05);关节置换组术后谵妄发生率、谵妄评定量表(DRS)评分、谵妄持续时间分别为36.11%、(20.48±3.14)分、(4.31±0.95)d,内固定组分别为17.95%、(15.36±2.84)分、(2.08±0.69)d,组间差异有统计学意义(P<0.05)。结论人工髋关节置换术是老年髋部骨折的较为安全的手术方式,患者术后髋关节功能恢复较好,但术后发生谵妄的比例、程度及持续时间均高于内固定治疗,因此在髋关节置换术后应注意对患者的意识、精神状态的观察,以提升治疗的安全性。

Objective To study the clinical effect of internal fixation and hip replacement in elderly patients with hip fractures.Methods A total of 114 elderly patients with hip fracture who underwent surgical treatment in our hospital from August 2017 to October 2018 were selected,they were divided into the internal fixation group(78 patients)and the joint replacement group(36 patients)according to the different surgical plans.Operative time,blood loss,postoperative loading time,the Harris scores and postoperative delirium were compared between two groups.Results The intraoperative blood loss,operative time,postoperative drainage volume and postoperative loading time in the joint replacement group were(171.49±9.64)mL,(78.15±10.62)min,(83.64±13.43)mL and(8.17±1.55)d,compared with(314.54±10.96)mL,(89.46±11.33)min,(108.46±15.94)mL,(29.43±3.42)d in the internal fixation group,the differences were statistically significant(P<0.05).The Harris scores of the joint replacement group after 6 months and 12 months of surgery were(85.46±6.33)and(85.91±5.20),which were significantly higher than(71.46±8.21)and(70.94±7.26)of the internal fixation group,the differences were statistically significant(P<0.05).The incidence of postoperative delirium,the delirium rating scale(DRS)score and the duration of delirium in the joint replacement group were 36.11%,(20.48±3.14)points,and(4.31±0.95)days,respectively,and those in the internal fixation group were 17.95%,(15.36±2.84)points,(2.08±0.69)d,the differences between groups were statistically significant(P<0.05).Conclusion Hip replacement is a safe method for elderly patients with hip fracture.The patients have better recovery of hip function after operation.However,the proportion,degree and duration of postoperative delirium are higher than that of internal fixation.Therefore,attention should be paid to the observation of the patient's consciousness and mental state after hip replacement to improve the safety of treatment.