全髋关节置换与人工股骨头置换修复老年股骨颈骨折:18个月随访比较  

Total hip replacement versus artificial femoral head replacement in repair of femoral neck fracture in the elderly: 18-month follow-up

作　　者：孙辉[1] 臧学慧[1] 高立华[1] 谭永滔 

机构地区：[1]南方医科大学附属南海医院骨二科,广东省佛山市528200

出　　处：《中国组织工程研究》2014年第53期8536-8541,共6页Chinese Journal of Tissue Engineering Research

基　　金：佛山市医学类科技攻关项目(201308209)~~

摘　　要：背景:老年股骨颈骨折患者行人工髋关节置换治疗,关于选择全髋关节置换还是人工股骨头置换目前仍存在争议。目的:比较人工股骨头置换与全髋关节置换修复老年人股骨颈骨折后18个月的随访结果。方法:纳入行人工髋关节置换的股骨颈骨折患者70例,男17例,女53例,年龄60-83岁,均为GardenⅢ型,Ⅳ型患者。根据置换方式分为两组,股骨头置换组39例,全髋关节置换组31例,两组患者性别、年龄、骨折分型及合并疾病构成上差异无显著性意义,具有可比性。X射线观察两组患者关节置换效果,综合比较两组患者术中输血量、术中失血量、术后引流量、手术时间、住院时间及置换后髋关节功能。结果与结论:经18个月随访,两组患者X射线显示股骨颈骨折均复位固定良好,假体位置良好。两组患者住院时间和术后引流量比较差异无显著性意义(P>0.05);两组患者术中输血量、失血量及手术时间比较,股骨头置换组优于全髋关节置换组(P<0.05);全髋关节置换组的髋关节功能恢复优良率显著高于股骨头置换组(P<0.05)。提示老年股骨颈骨折行全髋关节置换后关节功能恢复较好,远期并发症较低,是老年人股骨颈骨折的首选治疗方法;人工股骨头置换具有手术时间短、出血少及输血量少等优点,适合身体状况差、活动量小及受伤前患肢已有功能障碍的高龄患者。BACKGROUND： It is still controversial whether artificial femoral head replacement or total hip replacement is selected in elderly patients with femoral neck fracture during artificial hip replacement. OBJECTIVE： To compare the 18-month follow-up outcomes of artificial femoral head replacement and total hip replacement for the treatment of femoral neck fractures in older adults. METHODS： A total of 70 elderly patients with femoral neck fracture were enrolled in this study. There were 17 males and 53 females, at the age of 60 to 83 years old. There were Garden III type and. W type. According to the type of placement, they were divided into two groups： 39 cases in femoral head replacement group and 31 cases in total hip replacement group. No significant differences in gender, age, fracture type and combined disease constitution were detected between the two groups, showing comparability. X-ray was used to observe replacement effects in both groups. Intraoperative blood transfusion amount, intraoperative blood loss, postoperative drainage, operation time, hospital stay and postoperative hip joint function were comprehensively compared between the two groups. RESULTS AND CONCLUSION： After 18-month follow-up, X-ray showed that femoral neck fracture reduction and fixation were good, and the prosthesis position was good in both groups. No significant differences in hospital stay and postoperative drainage were detectable between both groups （P 〉 0.05）. Intraoperative blood transfusion, blood loss and operation time were better in the femoral head replacement group than in the total hip replacement group （P 〈 0.05）. The excellent and good rate of hip joint function recovery was significantly higher in the total hip replacement group than in the femoral head replacement group （P 〈 0.05）. These results suggested that functional recover of joints after total hip replacement was better and long-term complications were less in the elderly with femoral neck fracture. Total hip replacement is the firs

关 键 词：股骨颈骨折 髋假体 关节成形术 置换 髋 股骨头 老年人 植入物 人工假体 老年 人工股骨头置换 全髋关节置换 随访结果 失血量 引流量 髋关节功能 

分 类 号：R318[医药卫生—生物医学工程]