全髋关节置换术与骨折内固定术治疗老年股骨颈骨折的疗效比较  

Efficacy comparison between total hip replacement and fracture internal fixation in elder patients with femoral neck fracture

作　　者：朱孟勇 吴洋洋[1] 

机构地区：[1]浙江中医药大学附属第一医院骨伤科,浙江杭州310000

出　　处：《中国现代医生》2016年第9期49-52,共4页China Modern Doctor

基　　金：浙江省自然科学基金资助项目(LY15H270008)

摘　　要：目的比较研究骨折内固定与全髋关节置换术在老年股骨颈骨折患者中的应用价值。方法 2013年8月～2014年10月期间收集67例老年股骨颈骨折患者,按手术方式不同随机分为观察组（全髋关节置换术）和对照组（空心钉骨折内固定）,记录手术用时、患者卧床时间、输血量等指标,使用Harris评分量表评估术后患者髋关节功能及手术疗效,记录并发症。结果与对照组比较,观察组手术时间较长、输血量较大,但术后患者卧床时间短;术后1年,观察组手术疗效优良率80.00%较对照组53.13%高,术后6个月及1年观察组Harris分值较对照组高;观察组并发症发生率（8.57%）较对照组（15.63%）低,再次手术率（8.57%）较对照组（28.12%）低（P均〈0.05）。结论与空心钉骨折内固定术相比,全髋关节置换术具有以下优势：（1）全髋关节置换后患者可很快下地负重活动,避免长期卧床导致诸多并发症,缩短康复时间;（2）全髋关节置换术能更好恢复伤前生理结构,有利于髋关节功能恢复,疗效更优,减少二次手术可能性。Objective To compare the application value of total hip replacement（THR） and fracture internal fixation in elder patients with femoral neck fracture. Methods A total of 67 elder patients with femoral neck fracture from August2013 to October 2014 were selected and divided into the observation group（THR） and the control group（cannulated screw internal fixation） according to different operation methods. The operation duration, time in bed, and volume of blood transfusion were recorded. The postoperative hip joint function of patients and effect of operation were assessed by Harris scale. The incidence of complications were recorded. Results Compared with the control group, the operation duration was longer and blood transfusion volume was larger in the observation group, but the time of patients in bed after operation was shorter. After one year of operation, the excellent and good rate of operation effect in the observation group was 80.00%, which was higher than the 53.13% in the control group. 6 months and 1 year after operation,the Harris score in the observation group was higher than that in the control group, the incidence rate of complications was lower in the observation group（8.57%） than in the control group（15.63%）, and the rate of reoperation was lower in the observation group（8.57%） than in the control group（28.12%）. All these differences were statistically significant（P〈0.05）. Conclusion Compared with cannulated screw internal fixation, THR has the following advantages：（1） patients receiving THR can get out of bed and bear load in a short time after operation, avoiding many complications that may be caused by long term immobilization and shortening the time of rehabilitation;（2）THR can restore the physiologic structure of hip joint more comprehensively, facilitating the functional rehabilitation of hip joint with better curative effect, and reducing the possibility of reoperation.

关 键 词：空心钉骨折内固定 全髋关节置换术 老年股骨颈骨折 髋关节功能 

分 类 号：R687.3[医药卫生—骨科学]