三种不同手术方式治疗老年移位型股骨颈骨折的临床效果对比

摘要

目的 探讨三种不同手术方式治疗老年移位型股骨颈骨折的临床效果.方法 对2013年5月至2015年5月本院收治的130例老年移位型股骨颈骨折患者的临床资料进行回顾性分析,按手术方式将其分为螺钉内固定组(37例)、股骨头置换组(45例)及全髋关节置换组(48例),比较三组患者的基本资料、手术时间、术中出血量、早期和晚期并发症发生率,并评价术后满1年的患者髋关节功能Harris评分.结果 全髋关节置换组患者手术时间和术中出血量均显著多于螺钉内固定组和股骨头置换组(P<0.05),股骨头置换组患者手术时间和术中出血量均显著多于螺钉内固定组(P<0.05).螺钉内固定组患者早期褥疮、晚期骨折不愈合及晚期股骨头缺血性坏死的发生率均显著高于全髋关节置换组和股骨头置换组(P<0.05),其余并发症发生率三组间比较无显著差异(P>0.05).三组患者的1年生存率两两比较无显著差异(P>0.05),但全髋关节置换组和螺钉内固定组相比接近显著(P=0.060),提示有一定差别.全髋关节置换组患者Harris评分优良率显著高于螺钉内固定组(P<0.05).结论 对于65~80岁老年移位型股骨颈骨折患者,应根据其年龄、骨折类型、身体耐受情况等因素选择合适的手术方式,对于活动能力要求较高及预计生存期较长的老年患者,可选择全髋关节置换术,其效果优于加压螺钉内固定术和股骨头置换术.%Objective To investigate the clinical effects of three different surgical methods in the treatment of displaced femoral neck fractures in elderly patients. Method 130 elderly patients from May 2013 to May 2015 in our hospital were selected as research objects. They were divided into screw fixation group (n=37), femoral head replacement group (n=45) and total hip arthroplasty group (n=48) according to surgical methods. Clinical data of three groups were analyzed retrospectively with basic information, operation time, amount of bleeding, early and late complications, and Harris score for the evaluation of follow-up of patients with hip joint function after surgery for 1 year. Result The operation time and the amount of bleeding of total hip arthroplasty group were significantly more than those of screw fixation group and femoral head replacement group (P<0.05), and the operation time and the amount of bleeding of femoral head replacement group were significantly more than those of screw fixation group (P<0.05). The rates of early bedsore and late fracture nonunion and avascular necrosis of screw fixation group were significantly higher than those of femoral head replacement group and total hip arthroplasty group (P<0.05), the incidence of other complications among the three groups had no significant differences (P>0.05). There were no significant differences among the three groups in the 1 year survival rate (P>0.05), but suggested some difference (P=0.060). The excellent and good rate of Harris score of total hip arthroplasty group was significantly higher than that of screw internal fixation group (P<0.05). Conclusion For elderly patients aged 65~80 with displaced femoral neck fractures, appropriate surgical approach should be based on age, fracture type, body tolerance and other factors, for the high requirements of activity and whois expected to have longer survival, the operation of total hip arthroplasty can be choosen and its effects is better compared with screw fixation surgery and artificial femoral head replacement.