全髋关节与人工股骨头置换治疗老年人股骨颈骨折临床疗效情况及对术后远期并发症发生率的影响分析

Clinical Efficacy of Total Hip and Artificial Femoral Head Replacement in the Treatment of Femoral Neck Fractures in the Elderly and its Influence on the Incidence of Postoperative Long-term Complications

目的:分析全髋关节与人工股骨头置换治疗老年人股骨颈骨折临床疗效情况及对术后远期并发症发生率的影响。方法:选取2017年1月—2019年10月吴川市人民医院骨三科住院治疗的230例老年股骨颈骨折患者作为研究对象,以双盲随机抽样法分为参照组和观察组,每组各115例。参照组采纳全髋关节置换术治疗,观察组采纳人工股骨头置换术治疗,对比两组患者手术指标、临床疗效、Harris评分、VAS评分、血清炎症因子、并发症发生率。结果:观察组手术时间、住院时间均短于参照组,观察组术中出血量、术后引流量均低于参照组,差异有统计学意义(t=36.891、16.947、71.015、39.958,P<0.05);观察组临床总有效率与参照组比较,差异无统计学意义(χ^(2)=0.518,P>0.05);治疗后,观察组Harris评分与参照组比较,差异无统计学意义(t=1.167,P>0.05),治疗后观察组VAS评分低于参照组,差异有统计学意义(t=26.770,P<0.05);治疗后,观察组血清IL-6、TNF-α均低于参照组,差异有统计学意义(t=15.404、29.659,P<0.05);观察组并发症发生率低于参照组,差异有统计学意义(χ^(2)=6.604,P<0.05)。结论:人工股骨头置换术与全髋关节置换术在老年股骨颈骨折治疗中临床疗效相当,但人工股骨头置换术的创伤性更小,术后患者疼痛感以及炎症反应更轻、并发症更少,临床医师应根据患者具体情况,选择最佳的治疗方案。

Objective: To analyze the clinical efficacy of total hip joint and artificial femoral head replacement in the treatment of femoral neck fractures in the elderly and their influence on the incidence of long-term postoperative complications. Methods: A total of 230 elderly patients with femoral neck fractures who were hospitalized from January 2017 to October 2019 were selected as the research subjects and divided into reference group and observatiaon group by double-blind random sampling, with 115 cases in each group. The reference group was treated with total hip replacement, and the observation group was treated with artificial femoral head replacement. The surgical indicators, clinical efficacy, Harris score, VAS score, serum inflammatory factors, and complication rates were compared between the two groups. Results: The operation time and hospital stay of the observation group were shorter than those of the reference group, and the intraoperative blood loss and postoperative drainage volume of the observation group were lower than those of the reference group, and the differences were statistically significant(t=36.891, 16.947, 71.015,39.958, P<0.05). There was no statistically significant difference in the clinical total effective rate between the observation group and the reference group(χ^(2)=0.518, P>0.05). After treatment, there was no statistically significant difference in Harris score between the observation group and the reference group(t=1.167, P>0.05). After treatment, the VAS score of the observation group was lower than that of the reference group, and the difference was statistically significant(t=26.770, P<0.05). After treatment, serum IL-6 and TNF-α in the observation group were lower than those in the reference group, and the difference was statistically significant(t=15.404, 29.659, P<0.05). The incidence of complications in the observation group was lower than that in the reference group, and the difference was statistically significant(χ^(2)=6.604, P<0.05). Conclusion: The clinical efficacy of artificial femoral head replacement and total hip replacement in the treatment of elderly femoral neck fractures is comparable. However, artificial femoral head replacement is less invasive, with less postoperative pain and inflammation, and fewer complications. Clinicians should choose the best treatment plan according to the specific situation of the patient.