半髋和全髋关节置换术治疗老年股骨颈骨折的疗效比较

Efficacy comparison of hemi-hip arthroplasty and total hip arthroplasty for treatment of elderly femoral neck fracture

目的比较半髋关节置换术(HHA)和全髋关节置换术(THA)治疗老年股骨颈骨折的疗效。方法将133例老年股骨颈骨折患者根据病情及患者意愿分为HHA组(采用HHA治疗,63例)和THA组(采用THA治疗,70例),每组划分为65~80岁和80岁以上2个年龄段。记录两组术中出血量、手术时间、髋关节活动度、步态指标(步速、步频、步长)。采用Harris评分评价髋关节功能。结果患者均获得随访,时间12~24(18.21±3.40)个月。(1)术中出血量、手术时间:两组不同年龄段比较差异均无统计学意义(P>0.05);不同年龄段THA组均长(多)于HHA组(P<0.05)。(2)髋关节活动度、步态指标:末次随访时两组65~80岁年龄段均优于80岁以上年龄段(P<0.05);不同年龄段两组比较差异均无统计学意义(P>0.05)。(3)Harris评分:末次随访时两组65~80岁年龄段均高于80岁以上年龄段(P<0.05);THA组不同年龄段均高于HHA组(P<0.05)。结论采用HHA和THA治疗老年股骨颈骨折,HHA在术中出血量、手术时间方面较THA具有优势,THA在髋关节功能恢复方面较HHA有优势。因此,对于预期寿命长、活动量较大或合并患髋骨关节炎的患者,建议行THA治疗;对于身体情况相对较差的高龄患者建议行HHA治疗。

Objective To compare the efficacy of hemi-hip arthroplasty(HHA)and total hip arthroplasty(THA)for elderly femoral neck fracture.Methods The 133 elderly patients with femoral neck fractures were divided into HHA group(63 patients were treated with HHA)and THA group(70 patients were treated with THA),according to the disease coditions and patient′s wishers,each group was divided into two age periods including 65~80 years old and above 80 years old.The intraoperative bleeding volume,surgical time,hip joint range of motion,and gait indicators(stride speed,stride frequency and stride length)in both groups were recorded.Harris scale was used to evaluate hip joint function.Results All patients were followed up for 12~24(18.21±3.40)months.①Intraoperative blood loss and operation time:there were no statistical differences for different age periods in two groups(P>0.05);however,for different age periods,the two indicators in THA group were longer(more)than those in HHA group(P<0.05).②Hip joint range of motion and gait indicators:at the last follow-up,the two indexes of 65~80 years old age period were better than those of above 80 years old period in two groups(P<0.05);there were no statistical differences for different age periods between two groups(P>0.05).③Harris scale:at the last follow-up,the index of 65~80 years old period was higher than that above 80 years old period in two groups(P<0.05);the different age periods of THA group were all higher than those of the HHA group(P<0.05).Conclusions Using HHA and THA for treatment of elderly femoral neck fractures,HHA has advantages over THA in terms of operation time and intraoperative blood loss,while THA has advantages over HHA in hip joint function recovery.Therefore,THA is recommended for patients with longer life expectancy,high activity or combined with hip osteoarthritis,while HHA is recommended for advanced aged patients with relatively poor physical conditions.