人工股骨头置换术与全髋关节置换术对老年股骨颈骨折患者髋关节功能的影响

Effect of artificial femoral head replacement and total hip replacement on hip function in elderly patients with femoral neck fractures

目的研究人工股骨头置换术(AFHR)与全髋关节置换术(THR)对老年股骨颈骨折(FNF)患者髋关节功能的影响。方法抽取2020年1月至2022年12月平顶山市第二人民医院收治的老年FNF患者62例,按照随机数字表法分为AFHR组与THR组,每组31例。AFHR组采用AFHR治疗,THR组采用THR治疗。对比两组围术期指标、髋关节功能恢复优良率、术前及术后14 d骨代谢指标[骨碱性磷酸酶(BALP)、骨钙素(BGP)]、凝血功能指标[D-二聚体(D-D)、纤维蛋白原(FIB)、红细胞压积(HCT)]水平及并发症发生率。结果与AFHR组相比,THR组术中出血量多,手术时间、住院时间长(P<0.05);THR组髋关节功能恢复优良率(90.32%,28/31)高于AFHR组(67.74%,21/31),P<0.05;术后14 d,THR组BALP、BGP水平高于AFHR组(P<0.05);术后14 d,THR组D-D、FIB、HCT水平低于AFHR组(P<0.05);THR组并发症发生率(3.23%,1/31)低于AFHR组(25.81%,8/31),P<0.05。结论与AFHR相比,THR治疗老年FNF的效果更好,能改善机体的骨代谢指标和凝血指标,促进患者髋关节功能恢复,且术后并发症较少,但存在术中出血量多、手术耗时和住院时间长的缺点,临床可根据具体情况选择合适的手术方式。

Objective To study the effect of artificial femoral head replacement(AFHR)and total hip replacement(THR)on hip function in elderly patients with femoral neck fractures(FNF).Methods A total of 62 elderly patients with FNF treated in the Second People’s Hospital of Pingdingshan from January 2020 to December 2022 were selected and they were divided into AFHR group and THR group by random number table method,with 31 cases in each group.The AFHR group was treated by AFHR,and the THR group was treated by THR.The perioperative indexes,excellent and good rate of hip joint function recovery,levels of bone metabolism indexes,including bone alkaline phosphatase(BALP)and boneγ-carboxyglutamic acid-containing protein(BGP),coagulation function indexes,including D-dimer(D-D),fibrinogen(FIB)and hematocrit(HCT),and the incidence of complications were compared between the two groups.Results Compared with the AFHR group,the THR group had more blood loss,longer operation time and longer hospital stay(P<0.05).The excellent and good rate of hip function recovery in the THR group(90.32%,28/31)was higher than that in the AFHR group(67.74%,21/31),and the difference was significant(P<0.05).The levels of BALP and BGP in the THR group were higher than those in the AFHR group 14 days after operation(P<0.05).The levels of D-D,FIB and HCT in the THR group were lower than those in the AFHR group 14 days after operation(P<0.05).The incidence of complications in the THR group(3.23%,1/31)was lower than that in the AFHR group(25.81%,8/31),P<0.05.Conclusions Compared with AFHR,THR has a better effect in the treatment of FNF in the elderly,which can improve bone metabolism and coagulation indexes,promote the recovery of hip joint function,with fewer postoperative complications.However,it has the disadvantages of more intraoperative blood loss,longer operation time and longer hospital stay.Surgery protocol should be formed according to practical condition in clinical.