半髋和全髋关节置换术治疗老年股骨颈骨折的疗效及安全性

Efficacy and safety of total hip arthroplasty and hemiarthroplasty in treatment of femoral neck fractures in the elderly

目的探讨半髋和全髋关节置换术治疗老年股骨颈骨折的疗效及安全性。方法回顾性分析2016年1月至2019年10月琼海市人民医院关节外科收治106例老年股骨颈骨折患者的临床资料,均按《成人股骨颈骨折诊治指南》采用髋关节置换术,按术式差异分为半髋关节置换术组(n=53例)及全髋关节置换术组(n=53例),比较两组手术指标、髋关节功能及疼痛情况、生活质量及安全性。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。结果两组输血例数、住院时间比较,差异无统计学意义(P>0.05);与半髋关节置换术组比较,全髋关节置换术组术中出血量、术后24 h引流量更多,卧床时间更长(P<0.05)。两组术后3个月Harris髋关节功能评分表(HHS)评分高于术前,不等长例数少于术前,疼痛视觉模拟评分(VAS)低于术前,且半髋关节置换术组与全髋关节置换术组比较,HHS评分更低,VAS评分更高(P<0.05);但两组术后3个月不等长例数比较,差异无统计学意义(P>0.05);两组术后3个月简明健康状况调查量表(SF-36)量表中总体健康状况、社会功能和情感职能维度评分比较,差异无统计学意义(P>0.05);全髋关节置换术组SF-36量表生理功能、生理职能、躯体疼痛、活力和精神健康维度评分高于半髋关节置换术组(P<0.05);全髋关节置换术组并发症发生率为3.77%(2/53),低于半髋关节置换术组的16.98%(9/53),差异有统计学意义(P<0.05)。结论半髋和全髋关节置换术治疗老年股骨颈骨折各具优势。术前一般状况欠佳且对术后功能要求不高老年患者宜采用半髋关节置换术,术前一般状况良好且对术后功能恢复有一定要求老年患者宜采用全髋关节置换术。

Objective To explore the efficacy and safety of hemi-hip and total hip joint replacement in the treatment of femoral neck fractures in the elderly.Methods A retrospective analysis was conducted on 106 elderly patients with femoral neck fractures who were admitted to our department from January 2016 to October 2019.All patients underwent hip arthroplasty following Guideline for the Diagnosis and Treatment of Adult Femoral Neck Fractures.They were divided into hemiarthroplasty group(n=53)and total hip arthroplasty group(n=53)based on the surgical technique they received.Operational indicators,hip joint function and pain,quality of life,and safety were compared between two groups.SPSS 22.0 software was used to process the statistical analysis,and depending on data type,student′s t test or Chi-square test was employed for intergroup comparison.Results There were no significant difference in the number of blood transfusion patients and length of hospital stay between two groups(P>0.05).Compared with the hemiarthroplasty group,the total hip arthroplasty group had more intraoperative blood loss,24-h postoperative drainage and longer bed-ridden time(P<0.05).In three months after surgery,the Harris hip score(HHS)was increased,the number of unequal length cases was decreased,and the score of Visual analogue scale(VAS)of pain was reduced in both groups when compared with the conditions before surgery.The HHS score was obviously higher and VAS score was notably lower in the hemiarthroplasty group than the total hip arthroplasty group(P<0.05),but no significant difference was found in the number of unequal length cases between two groups in three months postoperatively(P>0.05).The results of medical outcomes study 36-item short from health survey(SF-36)in three months after surgery showed there were no significant differences in the scores of overall health status,social function and emotional function between two groups(P>0.05),but the total hip arthroplasty group had higher SF-36 scores of physiological function,role-physical,physical pain,vitality and mental health than the hemiarthroplasty group(P<0.05).The complication rate was 3.77%(2/53)in the total hip arthroplasty group,which was significantly lower than that of hemiarthroplasty group[16.98%(9/53),P<0.05].Conclusion Hemiarthroplasty and total hip arthroplasty have their own advantages in the treatment of elderly patients with femoral neck fractures.For those with poor preoperative general condition and low postoperative functional requirements,it is advisable to undergo hemiarthroplasty.While,for those with good preoperative general condition and certain requirements for postoperative functional recovery,total hip arthroplasty is recommended.