髋关节置换术治疗股骨颈骨折的回顾性研究

摘要

Objective The aim of this retrospective study was to analyse the clinical features of the femoral neck fractures patients treated with arthroplasty,compare the outcome of THA with HA in patients with femoral neck fractures and explore potential predictors of functional outcome. Methods We introduce a single-center retrospective study.All patients who underwent arthroplasty for femoral neck fractures in Department of orthopeadics and traumatology,Peking University People’s Hospital were identified retrospectively.Age,gender,injury causes,fracture pattern,fracture side,complications,operating room times,blood loss volumes,duration of hospital stays and functional outcome were analyzed. Results 490 patients with femoral neck fractures underwent arthroplasty (202 HA,288 THA),145 patients were male and 345 patients were female. The average age is(75.3 ± 9.5).The dominant fractures type was Garden IV according to Garden classification.Most fractures were caused by fall damage.The patients in the HA group were older than that in the THA group (P< 0.001).The average operating room times and blood loss volumes in THA were more than in HA (P< 0.001).Other results were not significantly differen.Logistic regression demonstrated that age correlated with worse Harris hip score (OR= 1.139,P< 0.001).Conclusion Most of the femoral neck fractures patients treated with arthroplasty were old female. Most fractures were caused by fall damage.HA is less traumatic compared with THA.The younger patients achieve better outcome.HA is suitable for older and weaker patients,while THA achieves better outcome in younger and healthier patients.%目的回顾性研究髋关节置换术治疗股骨颈骨折患者的临床特点，对比半髋置换术和全髋置换术治疗股骨颈骨折的效果，分析影响患者髋关节评分的因素。方法单中心回顾性研究，随访于北京大学人民医院创伤骨科行髋关节置换术治疗股骨颈骨折的患者490例。对所有患者的年龄、性别、受伤原因、骨折类型、患肢侧别、伴随疾病、手术时间、出血量、住院时间、术后髋关节功能情况等方面进行统计分析。结果因股骨颈骨折行髋关节置换术的患者共490例，半髋关节置换术202例，全髋关节置换术288例。男145例，女345例，所有患者平均年龄(75.3±9.5)岁。骨折类型主要为Garden IV型，摔伤是患者的主要致伤原因。半髋置换组对比全髋置换组，患者年龄更大、手术时间更短、术中出血量更少（P＜0.001）。多因素Logistic回归分析表明年龄是影响患者髋关节功能评分的独立影响因素，年龄越大，优良率越低（OR=1.139，P＜0.001），术式对患者髋关节评分影响无统计学意义（P=0.336）。结论髋关节置换术治疗股骨颈骨折患者多为老年女性，多由摔伤等低能量损伤导致。半髋置换术较全髋置换术对患者的创伤更小。患者年龄越大，术后髋关节功能越差。年龄较大、身体条件差的患者可考虑行半髋关节置换术治疗，年龄较小、身体条件好的患者可考虑行全髋关节置换术治疗。