人工股骨头置换术和人工全髋关节置换术治疗高龄股骨颈骨折的临床疗效

Clinical Effect of Femoral Head Replacement and Total Hip Replacement in the Treatment of Femoral Neck Fracture in Elderly Patients

目的:对高龄股骨颈骨折(Femoral neck fractures,FNF)患者实施人工全髋关节置换术(Total hip arthroplasty,THA)和人工股骨头置换术(Artificial femoral head replacement,AFHR)治疗,在对比探究2种手术方式的临床疗效。方法:回顾性选取我院2020年1月-2022年1月收治的FNF患者为对象展开分组对比研究,选出65例高龄患者后按不同手术方法将其分为对照组(32例)和观察组(33例),对照组实施THA;观察组实施AFHR。比较2组临床疗效、围术期指标、髋关节功能、不同时间视觉模拟法(Visual Analogue Scale/Score,VAS)评分、手术应激指标水平、术后并发症发生率。结果:观察组相较于对照组的临床治疗总有效率更高(X^(2)=5.346,P<0.05);观察组相较于对照组首次下床活动时间、手术时间、出院时间均更短(t=3.642、3.085、3.627,P<0.05);观察组术中出血量少于对照组(t=3.395,P<0.05);观察组相较于对照组并发症发生率更低(X^(2)=4.861,P<0.05)。2组术前髋关节功能评分(Harris)无统计学意义(t=0.332,P>0.05);观察组术后Harris评分高于对照组(t=3.088,P>0.05)。术前2组VAS评分对比显示差异无统计学意义(t=0.252,P>0.05);观察组术毕时、术后12小时、术后24小时VAS评分均低于对照组(t=3.567、3.333、3.142,P<0.05)。2组治疗前皮质醇(Cortisol,Cor)、肾上腺素(Epineph-rine,E)、肿瘤坏死因子α(Tumor necrosis factor α,TNF-α)、C反应蛋白(C-reactive protein,CPR)水平差异均无统计学意义(t=0.060、0.097、0.494、0.196,P>0.05);观察组治疗后Cor、E、TNF-α、CPR水平均低于对照组(t=2.450、2.754、3.294、3.188,P<0.05)。结论:采用AFHR治疗高龄FNF患者比实施THA所用手术时间更短,术中出血量更少,可以缩短下床活动时间、出院时间,降低应激反应,缓解疼痛,有助于恢复髋关节功能,继而提高手术治疗效果,并减少术后并发症。

Objective:Elderly patients with femoral neck fractures(FNF)were treated with total hip arthroplasty(THA)and artifi-cial femoral head replacement(AFHR),in order to compare the clinical ficacy of the two surgical methods.Methods:From January 2020 to January 2022,65 elderly patients with FNF were retrospectively selected from our hospital as the objects for group comparative study.According to different surgical methods,they were divided into a control group(32 cases)and an observation group(33 cases).The observation group was given AFHR.The clinical eficacy,perioperative indexes,hip function,Visual Analogue Sca/Score(VAS)scores at different time,the level of surgical stress indexes and the incidence of postoperative complications were compared between the two groups.Results:The total effective rate of clinical treatment in the observation group was higher than that in the control group(X^(2)-5.346,P<0.05).The time of first out-of-bed activity,operation time and discharge time in the observation group were shorter than those in the control group(t=3.642,3.085,3.627,P<0.05).The intraoperative blood loss of the observation group was less than that of the control group(t=3.395,P<0.05).The incidence of complications in the observation group was lower than that in the control group(X^(2)=4.861,P<0.05).Preoperative hip function score(Harris)was not statistically significant between the two groups(t=0.332,P>0.05).The Harris score of the observation group was higher than that of the control group(t=3.088,P>0.05).There was no significant difference in VAS score between the two groups before operation(t=0.252,P>0.05).The VAS scores of the observation group at the end of operation,12 h and 24 h after operation were significantly higher than those of the control group(t=3.567,3.333,3.142,P>0.05).Before treatment,the levels of cortisol(Cor),epinephrine(E),tumor necrosis factorα(TNF-α),C-reactive protein(CRP)in the two groups were significantly higher than those in the control group(P<0.05).CPR)level had no statistically significant difference(t=0.060,0.097,0.494,0.196,P>0.05).After treatment,the levels of Cor,E,TNF-αand CPR in the observation group were lower than those in the control group(t=2.450,2.754,3.294,3.188,P<0.05).Conclusion:Compared with THA,AFHR in the treatment of elderly patients with FNF has shorter operation time,less intraoperative blood loss,shorter out-of-bed activity time,discharge time,reduce stress response,relieve pain,help to restore hip joint function,and then improve the surgical treatment effect,and reduce postoperative complications.