人工双动全髋置换治疗脑卒中偏瘫股骨颈骨折的临床研究

Clinical Study of Total Hip Replacement Using Dual Mobility Cup in the Treatment of Femoral Neck Fracture in Patients with Hemiplegia after Stroke

目的探讨人工双动全髋置换治疗脑卒中偏瘫股骨颈骨折的效果。方法回顾性分析2020年1月至2023年1月100例手术治疗脑卒中偏瘫股骨颈骨折患者的临床资料。根据手术方法不同分组为研究组(行人工双动全髋关节置换术)54例、对照组(行人工股骨头置换术)46例。比较2组围术期指标、术后3和6个月髋关节功能(Harris评分)、术前及术后3和6个月疼痛视觉模拟评分法(VAS)评分、术前及术后3个月炎性因子[肿瘤坏死因子-α(TNF-α)和白细胞介素-1(IL-1)]水平,记录2组术后并发症和术后1年的手术优良率。结果研究组术中出血量多于对照组,手术时间、开始下床时间和住院时间均长于对照组(P<0.01)。研究组术后3、6个月Harris评分均高于对照组(P<0.05)。2组术后3、6个月VAS评分均低于术前,且研究组低于对照组(P<0.05)。2组术后3个月TNF-α、IL-1水平均低于术前,且研究组低于对照组(P<0.05)。研究组术后并发症总发生率3.70%(2/54)低于对照组17.39%(8/46)(P<0.05)。2组手术优良率对比差异不显著(P>0.05)。结论人工双动全髋关节置换术治疗脑卒中偏瘫股骨颈骨折手术时间较长,术中出血较多,但术后并发症较少,可较好改善患者炎症、髋关节功能及疼痛水平。

Objective To explore the curative effect of total hip replacement using dual mobility cup(DMC)in the treatment of femoral neck fracture in patients with hemiplegia after stroke.Methods The clinical data of 100 patients receiving operation for femoral neck fracture and hemiplegia after stroke from January 2020 to January 2023 were retrospectively analyzed.According to the different surgical methods,they were divided into the research group(total hip replacement using DMC,n=54)and the control group(artificial femoral head replacement,n=46).Perioperative indexes,hip function at 3 and 6 months after operation(Harris score),visual analogue scale(VAS)scores before operation and at 3 and 6 months after operation,inflammatory factors[tumor necrosis factor-α(TNF-α)and interleukin-1(IL-1)]levels before operation and at 3 months after operation were compared between the two groups.The postoperative complications and the excellent and good rate at 1 year after operation were recorded in the two groups.Results The intraoperative blood loss in the research group was greater than that in the control group,and the duration of operation,the time of first off-bed activity and length of hospital stay were longer than those in the control group(P<0.01).The Harris scores of the research group were higher than those of the control group at 3 and 6 months after operation(P<0.05).VAS scores at 3 and 6 months after operation were lower in the two groups than those before operation,and lower in the research group than in the control group(P<0.05).The levels of TNF-αand IL-1 in the two groups at 3 months after operation were lower than those before operation,and the levels in the research group were lower than those in the control group(P<0.05).The total incidence of postoperative complications in the research group was 3.70%(2/54),which was lower than that in the control group[17.39%(8/46)](P<0.05).There was no significant difference between the two groups with respect to the excellent and good rate(P>0.05).Conclusion In the treatment of femoral neck fracture in patients with hemiplegia after stroke,total hip replacement using DMC leads to longer duration of operation,more intraoperative blood loss,but fewer postoperative complications,which can better improve the inflammation,hip function and pain level of patients.