全髋与半髋关节置换术治疗老年人股骨颈骨折结果比较

Comparison of results between total hip arthroplasty and hemiarthroplasty for fe moral neck fractures in the elderly

目的比较全髋关节置换术与半髋关节置换术治疗老年人完全移位股骨颈骨折的疗效。方法将1995～2001年在我院治疗的262例60岁以上有移位的股骨颈骨折患者分为两组,A组为全髋关节置换术,B组为人工股骨头置换术。随访12～78个月,平均37个月。结果按Harris评分标准,A组术后优良率达到93.8%;B组术后优良率达78.4%,单极与双极股骨头置换组之间结果没有明显的差别;人工股骨头置换后有5例需行全髋翻修手术;双极人工股骨头置换中有2例发生双极之间脱位,7例出现假体周围骨溶解。结论人工股骨头或全髋关节置换术是治疗老年股骨颈骨折的有效方法,可提高老年人的生活质量,减少并发症。全髋关节置换结果优于人工股骨头置换。

Objective To compare the effects of hemiarthroplasty and tho se of total hip arthroplasty (THA) in treatment of the displaced fracture of fem oral neck in the elderly. Methods From 1995 to 2001, 262 elderly patients of ove r sixty years old with displaced femoral neck fracture (Garden Types Ⅲ-Ⅳ) wer e operated on with total hip arthroplasty or hemiarthroplasty (unipolar or bipol ar). The follow-up period ranged from 12 to 78 months (mean, 37 months). Resul ts There were no significant differences in the rates of postoperative medical c omplication or dislocation between unipolar group and bipolar group. Twenty-one patients died during the follow-up. Forty-three patients were lost to follow -up. According to Harris scoring system, there were 90 excellent or good cases (93.8%) in THA group and 80 excellent or good cases (78.4%) in hemiarthropl asty group. Five cases of hemiarthroplasty needed to be given THA afterwards. In bipolar endoprostheses, an inner dislocation between the bipolar locking system s occurred in 2 cases, and osteolysis around component appeared in 7 cases. Con clusions Both THA and hemiarthroplasty are reasonable choices for treatment of d isplaced fracture of femoral neck in the elderly, but the results of THA are bet ter than those of hemiarthroplasty. Based on the results of this study, there is no obvious advantage in the use of a bipolar compared with an unipolar hemiarth roplasty. The bipolar endoprosthesis should be very carefully undertaken for the inner dislocation because of very high wear rate of inner polyethylene liner.