股骨颈骨折患者内固定方法及人工假体的选择  

Internal fixation and prosthesis selection for the treatment of femoral neck fracture

作　　者：高辉[1] 吕厚山[2] 

机构地区：[1]赣南医学院第一附属医院骨科,江西省赣州市341000 [2]北京大学人民医院关节病诊疗研究中心,北京市100044

出　　处：《中国组织工程研究与临床康复》2007年第51期10251-10254,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:评价股骨颈骨折患者骨折内固定术与人工股骨头置换术、全髋关节置换术治疗的价值和选择。方法:①试验对象:选择1999-01/2003-12本院收治的180例性别、随访时间均相仿的股骨颈骨折患者。纳入标准:①接受过随访者。②患者对治疗及试验知情同意。排除标准:排除无关死亡、失去随访或资料不全者。将180例患者分为骨折内固定组、人工股骨头置换组和全髋关节置换组,每组60例。②试验方法:根据骨折类型、患者年龄、骨质条件及伴发内科疾病情况选择内固定及假体置入。骨折内固定组采用多根加压中空螺钉固定;人工股骨头置换组采用髋关节外侧切口入路,应用双极人工股骨头置换;全髋关节置换组根据年龄选择相应的假体进行手术。③实验评估:观察所有患者的住院情况,并对术后1,3年的骨折愈合情况进行评定。结果:纳入180例股骨颈骨折患者,均进入结果分析。①3种术式的住院时间相仿,早期并发症均较低;骨折内固定组及人工股骨头置换组的中、远期并发症、再手术率较高,全髋关节置换组手术创伤、假体费用较大,随访功能优良率较高。②术后1年骨折内固定组骨折愈合52例,髋关节功能评定为(87.31±7.12)分;人工股骨头置换组和全髋关节置换组术后1年假体无明显松动,髋关节功能评定分别为(89.31±3.43)分和(93.11±5.11)分。③术后3年骨折内固定组8例出现股骨头缺血性坏死,髋关节功能评定为(78.33±10.63)分;人工股骨头置换组和全髋关节置换组分别有7例及2例发生假体松动,髋关节功能评定为(88.72±3.17)分和(91.72±3.17)分。结论:适应证掌握正确,多根加压中空螺钉固定及人工股骨头置换和人工全髋关节置换3种治疗股骨颈骨折均可达到较满意的效果。严格正确的掌握适应症可能是预防中远期并发症的有效措施。AIM: To evaluate the curative effect and selection of internal fixation, hemiarthroplasty and total hip replacement for the treatment of femoral neck fracture. METHODS: ①Between January 1999 and December 2003, 180 cases of femoral neck fracture hospitalized with similar follow up were selected. The informed consent of treatment was obtained from them. Those dead with unrelated reasons, lost from the follow up and with no complete clinical data were excluded. All subjects were divided into internal fixation group, hemlarthroplasty group and total hip replacement group with sixty cases in each group. ②According to the fracture types, age, bone condition and complications of internal diseases, the patients were treated by internal fixation with many cannulated compression screws or prosthesis implantation including hemiarthroplasty with the lateral incision of hip joint and total hip replacement with the adaptive prosthesis according to the age. ③The hospital information and the functional assessment of 1 and 3 years after operation were evaluated. RESULTS: All 180 patients were involved in the result analysis. ①The time of hospitalization of the three groups was similar, and the complications at the early stage were not remarkable. The middle and long-term complications and secondary surgery rate were relatively higher in internal fixation and hemiarthroplasty groups, while in total hip replacement group, the surgical trauma was more severe, the prosthesis was more expensive and the function was better. ②One year after operation, 52 cases in internal fixation group were healed up, and Harris score was (87.31±7.12) points. Prosthesis loosening was not found in hemiarthroplasty and total hip replacement group and their Harris scores were (89.31±3.43) and (93.11±5.11) points, respectively. ③Eight cases in internal fixation group developed femoral head necrosis with the Harris score of (78.33±10.63) points after 3 years. There were 7 cases and 3 cases with prosthesis loosening and the Harris scores were

关 键 词：股骨颈骨折 不同治疗方法 疗效 

分 类 号：R683[医药卫生—骨科学]