加压空心钉与全髋关节置换治疗老年股骨颈骨折的疗效分析  

Treatment of femoral neck fractures by total hip replacement and compressed hollow screws in the aged

作　　者：张殿英[1] 付中国[1] 杨明[1] 王艳华[1] 张宏波[1] 姜保国[1] 

机构地区：[1]北京大学人民医院创伤骨科,北京大学交通医学中心,100044

出　　处：《中华创伤骨科杂志》2009年第5期443-445,共3页Chinese Journal of Orthopaedic Trauma

基　　金：国家“十一五”科技支撑计划基金（2007BA104806）

摘　　要：目的回顾性分析加压空心钉内固定术和全髋关节置换（THA）治疗老年股骨颈骨折的疗效。方法2002年1月至2008年6月共收治新鲜股骨颈骨折患者193例，符合入选标准者共60例，27例行加压空心钉内固定治疗，33例行THA。对两组患者的手术时间、术中出血量、住院时间、患肢术后下地活动时间、术后1年患髋Harris功能评分优良率、术后并发症发生率及再手术率进行比较。结果60例患者随访时间为12～56个月，平均32．5个月。两组患者在手术时间、出血量、住院时间及下地时间差异有统计学意义（P〈0．05），在术后1年患髋Harris功能评分优良率、术后并发症发生率及再手术率差异无统计学意义（P〉0．05）。空心钉内固定组术后Harris评分优良率为85．2％，THA组为93．9％。空心钉内固定组患者中股骨头坏死3例（11．1％），骨折不愈合1例（3．7％）。THA组患者中因假体松动行二次手术者2例（6．1％），另有髋关节脱位1例（3．0％）。结论对于无移位股骨颈骨折均采取内固定治疗；年龄小于70岁、活动能力好、骨质量好的老年移位型股骨颈骨折患者首选闭合或切开空心钉内固定术，保留股骨头是首选；有严重内科合并症不能耐受关节置换的老年患者可采用空心钉内固定治疗；年龄大于70岁的移位骨折及粉碎性骨折患者、伴有严重骨质疏松症或有其他老年病不宜长期卧床者、髋关节本身有骨关节炎的患者首选THA。Objective To compare the therapeutic effects of total hip arthroplasty （THA） and compressed hollow screws in the treatment of femoral neck fractures. Methods From January 2002 to June 2008, we treated 193 cases of fresh femoral neck fracture. Of them, 60 were included in the present study. Thirty-three cases were treated by compressed hollow screws （group A）, and 24 cases by THA （group B）. Their follow-up time ranged from 12 to 56 months. Therapeutic effects were statistically analyzed in terms of time interval from injury to operation, complications, bed-ridden time, and functional recovery. Results By Harris scoring, group A had an excellent to good rate of 85.2% and group B had 93.9%. The complications and rate were relatively higher in IF group. There were 3 cases （11. 1% ） of femoral head necrosis and 1 case of nonunion （3.7%） in group A, while there were 2 cases （6.1%） of prosthesis loosening which were managed by secondary surgery and 1 case （3.0%） of hip dislocation in group B. Conclusions THA and compressed hollow screws are both effective for the aged patients with femoral neck fracture, but their indications should be strictly followed. Compressed hollow screws can also be applied to patients over 70 years old. For patients with large displacement or osteoporosis, THP should be the first choice.

关 键 词：股骨颈骨折 骨折固定术 内 关节成形术 置换 髋 老年人 

分 类 号：R686[医药卫生—骨科学]