空心加压螺纹钉内固定与人工关节置换术治疗老年股骨颈骨折

Treatment of Femoral Neck Fractures with AO Hollow Pulling Screw and Artificial Hip Replacement

目的 比较空心加压螺纹钉内固定与人工关节置换术治疗老年股骨颈骨折的疗效。 方法 从本院自 1998年 1月～ 2 0 0 2年 3月收治的股骨颈骨折患者中选出年龄 >5 5岁 ,骨折类型为GardenⅢ、Ⅳ型 ,伤后时间在 1周以内手术的 12 0例患者 ,分别采用空心加压螺纹钉内固定、人工股骨头置换和人工全髋关节置换术三种方法治疗 ,并进行回顾分析。 结果 所有病例随访 10～ 39个月 ,平均 2 4 5个月 ,空心加压螺纹钉内固定、人工股骨头置换和人工全髋关节置换术三组术后功能优良率分别为 :73% ,84 % ,86 % ,其中内固定组与人工关节置换组之间有差异 (P <0 0 5 ) ,人工股骨头置换和人工全髋关节置换组之间无差异 (P >0 0 5 )。 结论 年龄在 6 5岁以下的新鲜基底部或嵌插型骨折 ,宜选用空心加压螺纹钉内固定 ,头下型或有严重移位的经颈型骨折 ,宜采用人工关节置换术。

Objective To evaluate the efficacy of AO hollow pulling screw and artificial hip replacement for the treatment of fractures of the femoral neck.Methods 120 cases of the femoral neck fractures treated by AO hollow pulling screw, hemiarthroplasty and total hip replacement between 1998 and 2002 were reviewed.Results The results show that functional recovery were satisfactory with 73%,84% and 86% in the three groups respectively, and the statistical significance was found between AO hollow pulling screw and artificial hip replacement(P<0.05), whereas there was no statistical significance between hemiarthroplasty and total hip replacement(P>0.05).Conclusion The results suggest that hollow pulling screw is suitable for the patients under 65 years old with the fresh fundus or insertion fractures, artificial hip replacement is suitable for the subcapital fracture or the displaced fracture of the femoral neck.