内固定、人工股骨头置换及全髋关节置换术治疗移位型股骨颈骨折比较  

Comparison of internal fixation,femoral head arthroplasty and total hip replacement in treatment of displaced femoral neck fractures

作　　者：万青红 王晓光[1] 常刚[1] 高文博[1] 

机构地区：[1]漯河市第三人民医院骨科,河南漯河462000

出　　处：《医药论坛杂志》2017年第10期51-53,共3页Journal of Medical Forum

摘　　要：目的比较内固定、人工股骨头置换及全髋关节置换术治疗移位型股骨颈骨折的效果。方法选取漯河市第三人民医院2012年2月—2013年11月骨科收治并得到有效随访的87例移位型股骨颈骨折。根据患者骨折类型、年龄、合并症等基础情况,分为空心螺钉内固定组(Internal Fixation,IF组)28例、人工股骨头置换术组(Femoral Head Arthroplasty,FHA组)31例、全髋关节置换术(Total Hip Replacement,THR组)28例。观察3组围手术期基本指标:手术时间、术中出血量、住院天数、手术住院费用,术后随访2年,观察3组髋关节功能恢复及并发症情况。结果 (1)3组住院时间、手术住院费用相较无显著差异(P>0.05),但IF组手术时间、术中出血量分别较FHA组、THR组低,差异有统计学意义(P<0.05);(2)(1)出院后有效随访2年,IF组髋关节功能Harris评分优良率(71.43%)较THR组(92.86%)低,差异显著(P<0.05),FHA组优良率(80.65%)居中。(2)FHA组远期并发症率9.68%,较THR组32.14%低,差异显著(P<0.05),IF组远期并发症率17.86%居中。结论内固定、人工股骨头置换及全髋关节置换术治疗移位型股骨颈骨折各有优缺点,临床医师可根据患者自身具体情况选取手术方式,提高治疗可靠性。Objective To compare the effect of internal fixation,femoral head arthroplasty and total hip replacement in the treatment of displaced femoral neck fractures. Methods From Feb. 2012 to Nov. 2013,a total of 87 patients with displaced femoral neck fractures in our hospital according to the type of fracture,age and comorbidities,there were 28 cases of Internal Fixation（ IF group）,31 cases of Femoral Head Arthroplasty（ FHA group）,31 cases of total hip joint Replacement（ Total Hip Replacement,THR group） in 28 cases.Observed their basic indicators such as operative time,intraoperative blood loss,hospital stay and hospitalization expenses. After treatment,all of these patients,whose hip joint function recovery and complications were observed,followed up for 2 years. Results There were no significant differences in hospital stay and hospitalization expenses between these three groups（ P〈0. 05）,but the operative time and intraoperative blood loss in the IF group were significantly lower than those in the FHA group and THR group（ P〈0. 05）.After following up for 2 years,the excellent rate of Harris score of hip joint function in the IF group was 71. 43%which was significantly lower than those in the THR group 92. 86% and the FHA group 80. 65%（ P〈0. 05）; the longterm complication rate in the FHA group was 9. 68% which was significantly lower than those in the THR group 32. 14%and the IF group 17. 86%（ P〈0. 05）. Conclusion Internal fixation,artificial femoral head replacement and total hip arthroplasty in the treatment of displaced femoral neck fractures have their own advantages and disadvantages,the clinician according to the specific circumstances of the patient selected surgical approach to improve the reliability of treatment.

关 键 词：移位型股骨颈骨折 IF FHA THR 

分 类 号：R683.42[医药卫生—骨科学]