不同假体半髋关节置换术治疗老年股骨颈骨折的效果观察

Observation of hemiarthroplasty with different hip prostheses in the treatment of femoral neck fractures in the elderly

目的探讨不同假体半髋关节置换术治疗老年股骨颈骨折的效果。方法前瞻性研究。抽取2018年1月至2020年1月信阳市第三人民医院骨科收治的71例拟行半髋关节置换术的老年股骨颈骨折患者作为研究对象,采用随机数字表法将其分为A组与B组。A组因未完成后续随访脱落1例,B组脱落1例,最终A组35例,B组34例。A组采用骨水泥型假体半髋关节置换术治疗,B组采用生物型假体半髋关节置换术治疗,所有患者均随访24个月。比较两组患者围术期指标(术后引流量、术中出血量、手术时间、住院时间);于术前及术后3、6、12个月使用髋关节功能评分量表(Harris)评估患者的髋关节功能;比较两组术前及术后3个月5-羟色胺(5-HT)与C反应蛋白(CRP)水平;记录两组术后24个月内并发症发生情况。结果两组患者手术时间、术后引流量、术中出血量比较,差异未见统计学意义(P>0.05);A组患者住院时间[(13.34±1.88)d]短于B组[(17.38±1.95)d],P<0.05。术后3、6、12个月,两组Harris评分均呈现出上升态势,A组变化幅度较B组更为明显,且各时点Harris评分均高于B组(P均<0.05)。术后3个月,A组CRP、5-HT水平均低于B组(P均<0.05)。术后24个月内,两组并发症发生率比较差异未见统计学意义(P>0.05)。结论与生物型假体相比,骨水泥型假体可改善患者的髋关节功能,降低患者体内炎症因子、致痛因子水平,缩短住院时间,但两种假体在并发症及围术期指标方面的效果相当。

Objective To investigate the effect of hemiarthroplasty with different hip prostheses in the treatment of femoral neck fractures in the elderly patients.Methods This study was a prospective study.Seventy-one elderly patients with femoral neck fractures who were admitted to the Department of Orthopedics of Xinyang Third People’s Hospital from January 2018 to January 2020 were selected as the research object,and the patients were divided into group A and group B by random number table method.Group A lost 1 case due to incomplete follow-up,while group B lost 1 case.In the end,there were 35 cases in group A and 34 cases in group B.Patients in group A were treated by hemiarthroplasty with bone cement prosthesis,while patients in group B were treated by hemiarthroplasty with biological prosthesis.All patients were followed up for 24 months.Perioperative indexes(postoperative drainage volume,intraoperative bleeding volume,operation time and hospital stay)were compared between the two groups.The hip joint function was evaluated with the Hip Joint Function Rating Scale(Harris)before operation,3 months,6 months and 12 months after operation.5-hydroxytryptamine(5-HT)and C-reactive protein(CRP)of the two groups were examined before and 3 months after operation.The complications within 24 months after surgery of the two groups were also recorded.Results There was no significant difference in operation time,postoperative drainage volume and intraoperative bleeding volume between the two groups(P>0.05).The hospital stay of group A was(13.34±1.88)d,shorter than the(17.38±1.95)d of group B(P<0.05).The Harris score of the two groups showed an upward trend 3,6 and 12 months after operation,the change range in group A was more obvious than that in group B,and the Harris score in group A was higher than that in group B at each time point(all P<0.05).The levels of CRP and 5-HT in group A were lower than those in group B 3 months after operation(P<0.05).Within 24 months after operation,there was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusions Compared with the biological prosthesis,the bone cement prosthesis can improve the hip joint function of patients,reduce the levels of inflammatory factors and algesic factors,and shorten the hospital stay.However,the effects of the two prostheses on complications and perioperative indicators are similar.