内固定术和全髋置换术治疗老年股骨颈骨折患者的比较

Comparison of internal fixation and total hip replacement in elderly patients with femoral neck fractures

目的对比分析60~75岁的股骨颈骨折患者采用内固定术和全髋置换术进行治疗的临床效果和费用,为该年龄段患者选择合适的手术方式提供参考依据.方法根据纳入及排除标准选取60~75岁股骨颈骨折空心钉内固定治疗患者69例,全髋置换术治疗患者88例,收集相关资料,分析两组之间临床特征及预后的差异.结果全髋置换组中位年龄为68(64,72)岁,大于内固定组[63(61,68)岁,Z=-4.536,P<0.001],内固定组男20例(29.0%),女49例(71.0%),全髋置换组男13例(14.8%),女75例(85.2%),两组女性均多于男性(χ^(2)=4.706,P=0.030).全髋置换组移位型/无移位型比例高于内固定组(90.9%和46.4%,χ^(2)=37.510,P<0.001).两组术后的血清白蛋白均低于术前,且全髋置换组平均下降多于内固定组[(9.06±3.45)g/L和(7.07±3.37)g/L,t=-3.393,P=0.001].全髋置换组术中出血量及输血量多于内固定组(均P<0.05),住院天数[12(9,14)d]及住院费用[89222.1(84826.8,93040.0)元]高于内固定组[9(8,10)d;51158.9(47816.5,54098.4)元,Z=-5.138,-10.737,均P<0.001].全髋置换组术后下地负重时间[32.0(28.0,36.5)d],早于内固定组[92.0(89.3,95.5)d,Z=-10.228,P<0.001].两种手术方式治疗非移位型股骨颈骨折患者术后1年时髋关节Harris评分优良率及生活质量评分EQ-5D比较差异均无统计学意义.对于移位型患者,全髋置换组术后1年时髋关节Harris评分优良率高于内固定组(97.5%和81.3%,χ^(2)=6.697,P=0.010);术后生活质量评分EQ-5D也优于内固定组[0.9(0.7,1.0)和1.0(1.0,1.0),Z=-4.785,P<0.001],术后疼痛和焦虑的发生率低于内固定组(6.3%,1.3%,28.1%,50.0%,χ^(2)=7.928,38.032,P均<0.01).结论内固定术与全髋置换术在死亡率、短期术后并发症等方面无明显差异.两种手术方式治疗非移位型股骨颈骨折患者术后功能无明显差异.对于移位型患者,全髋置换术术后功能优于内固定术.内固定术初次住院费用低于全髋置换术.

I Objective To compare the clinical results and costs of treatment between internal fixation and total hip replacement in patients aged 60 to 75 years with femoral neck fractures,in order to provide a reference basis for choosing the appropriate surgical procedure for patients in this age group.1 Methods According to the inclusion and exclusion criteria,we selected 69 patients treated with internal fixation and 88 patients treated with total hip replacement for femoral neck fractures,and icollected relevant data to analyze the differences in clinical characteristics and prognosis between the two groups.Results The total hip replacement group was older than the internal fixation group[68(64,72)us.63(61,68),Z=-4.536,P<0.001J.There were 20 men(29.0%)and 49 women(71.0%)in the internal fixation group,and 13 men(14.8%)and 75 women(85.2%)in the total hip replacement group.Both groups had more women than men(χ^(2)=4.706,P=0.030).The ratio of the displaced type to the non-displaced type was higher in the total hip replacement group than in the internal fixation group(90.9%us.46.4%,χ^(2)=37.510,P<0.001).Postoperative serum albumin levels were lower than preoperative levels in both groups,with greater decreases in the total hip replacement group than in the internal fixation group[(9.06±3.45)g/L us.(7.07±3.37)g/L,t=3.393,P=0.001J.The total hip replacement group had a higher intraoperative bleeding volume and blood transfusion volume than the internal fixation group(P<0.o5),and the days of hospitalization[12(9,14)dJand hospitalization costs[Y89222.1(84826.8,93040.0)Jwere higher than those in the internal fixationgroup9(810)d;￥51158.9(47816.5,54098.4),Z=-5.138,-10.737,P<0.001 for bothj.Weight-bearing after total hip replacement occurred earlier than the internal fixation group[32.0(28.0,36.5)d us.92.0(89.3,95.5)d,Z=-10.228,P<0.001].There were no significant differences between the two types of surgery for non-displaced femoral neck fractures at 1 year after surgery in the Harris hip score and the quality of life score EQ-5D.For patients with displacement,the rates of excellent and good outcomes based on the Harris score for the total hip replacement group were significantly higher than those for the internal fixation group at 1 year after surgery(97.5%us.81.3%,χ^(2)=6.697,P=0.010);the postoperative quality of life score EQ-5D was also better than that of the internal fixation groupL0.9(0.7,1.0)us.1.0(1.0,1.0),Z=-4.785,P<0.001],and the incidence of postoperative pain and anxiety was lower than that in the internal fixation group(6.3%us.28.1%,1.3%,vs.50.0%,χ^(2)=7.928,38.032,all P<0.01).Conclusions The mortality and short-term postoperative complications between internal fixation and total hip replacement have no significant differences.There is no significant difference in postoperative function between the two surgical methods for patients with non-displaced femoral neck fractures.For patients with displacement,total hip arthroplasty is superior to internal fixation.The cost of initial hospitalization for internal fixation is significantly lower than for total hip replacement.