不同术式治疗老年股骨颈骨折的近远期疗效对比

Comparison of short-term and long-term effects of different surgical methods in the treatment of femoral neck fractures in the elderly

目的:比较人工股骨头置换术(AFHR)、人工全髋关节置换术(THA)治疗老年股骨颈骨折的近远期疗效。方法:选取90例老年股骨颈骨折患者为研究对象,按照不同手术方式分为AFHR组和THA组,每组各45例。比较两组患者术中指标,术后1、3、7 d时疼痛视觉模拟评分(VAS),术后1、3、6、12个月时Harris评分,术后近期并发症,二次手术情况。结果:与THA组相比,AFHR组手术时间更短、术中出血量及术后引流量更少(P<0.05)。AFHR组在术后1、3、7 d时VAS评分及在术后1、3、6、12个月时Harris评分低于THA组(P<0.05)。两组患者术后近期并发症总发生率及随访期内二次手术率比较,差异无统计学意义(P>0.05)。结论:AFHR和THA均可有效恢复老年股骨颈骨折患者髋关节功能,其中AFHR手术时间更短、术中出血量及术后引流量更少,更适合于身体状况较差的老年患者,而THA患者的髋关节功能恢复的更好。

Objective:To compare the short-term and long-term efficacy of artificial femoral head replacement(AFHR) and total hip arthroplasty(THA) in the treatment of femoral neck fractures in the elderly.Methods:90 elderly patients with femoral neck fracture were divided into two groups according to different surgical methods, AFHR group(n=45) and THA group(n=45).The surgical indexes, visual analogue scale(VAS) at 1,3,and 7 days after operation, Harris score at 1,3,6,and 12 months after operation, the short-term postoperative complications and secondary operation were compared between the two groups.Results:Compared with THA group, AFHR group had shorter operation time, less intraoperative blood loss and postoperative drainage volume(P<0.05).The VAS scores at 1,3,and 7 d after operation, and Harris score at 1,3,6,and 12 months after operation of AFHR group were lower than those of THA group(P<0.05).There was no significant difference in the total incidence of postoperative complications and reoperation rate between the two groups(P>0.05).Conclusion:AFHR and THA can effectively restore the hip joint function in elderly patients with femoral neck fracture.AFHR has shorter operation time, less intraoperative blood loss and blood transfusion, and is more suitable for elderly patients with poor physical conditions, while THA has better recovery of hip joint function.