人工股骨头置换术和全髋关节置换术对老年股骨颈骨折患者的疗效及预后对比分析  

Comparative Analysis of the Effect and Prognosis of Artificial Femoral Head Replacement and Total Hip Replacement in Elderly Patients with Femoral Neck Fracture

作　　者：张凯[1] 邓迎杰[1] 洪汉刚[1] Zhang Kai;Deng Yingjie;Hong Hangang(Department of Orthopedics,the Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University,Urumqi 830000,Chin)

机构地区：[1]新疆医科大学附属中医院骨二科

出　　处：《国际老年医学杂志》2018年第4期163-167,共5页International Journal of Geriatrics

基　　金：新疆维吾尔自治区自然科学基金资助项目面上项目(2015211C145)

摘　　要：目的探讨人工股骨头置换术和全髋关节置换术对老年股骨颈骨折患者的疗效及预后情况，为手术方式的选择提供临床参考。方法选取2014年4月-2016年5月在我院接受治疗的股骨颈骨折患者86例，采用乱数表法将患者分为对照组和观察组各43例。对照组患者给予人工股骨头置换术进行治疗，观察组给予全髋关节置换术进行治疗。比较两组患者的手术时间、术中出血量、术中输血量、术后引流量、住院时间。对患者进行至少1年的随访，比较两组患者术前和术后1个月血清肿瘤坏死因子-α（TNF-α）和白介素-1（IL-1）水平，比较两组患者术后6个月和12个月的髋关节功能优良率，记录随访过程中两组患者出现的并发症。结果观察组的手术时间和住院时间分别为（109．33±30．39）min、（13．69±2．74）d，均长于对照组的（78．26±22．69）min、（12．12±2．27）d（P〈0．05）；观察组的术中出血量和术中输血量分别为（422．57±116．68）ml、（291．21±42．16）ml，均多于对照组的（171．48±95．62）ml、（90．16±19．21）ml（P〈0．05）；两组的术后引流量无统计学差异（P〉0．05）；术后1个月观察组血清TNF-α、IL-1水平低于对照组（P〈0．05）；两组术后6个月的髋关节功能优良率无统计学差异（P〉0．05）；观察组术后12个月的髋关节功能优良率为88．37％，高于对照组69．77％（P〈0．05）；观察组的总并发症发生率为11．63％，低于对照组的30．23％（P〈0．05）。结论人工股骨头置换术和全髋关节置换术治疗股骨颈骨折均有较好的疗效，前者手术操作简单、创伤小，后者远期疗效更佳、可有效改善炎症反应，并发症少，临床上可综合患者的实际情况来选择合适的手术方法。Objective To compare the effect and prognosis of artificial femoral head replacement and total hip replacement in elderly patients with femoral neck fracture. Methods 86 cases with femoral neck fracture who were treated in our hospital from A- pril 2014 to May 2016 were selected. The patients were divided into the observation group and the control group according to random number table, 43 cases in each group. The control group was treated with artificial femoral head replacement, and the observation group was treated with total hip replacement. The operation time, blood loss, blood transfusion volume, postoperative drainage vol- ume and hospitalization time were noted. The patients were followed up for at least 1 year. The serum levels of tumor necrosis factor （ TNF - α） and interleukin - 1 （ IL - 1 ） were measured before operation and 1 month after operation. The hip function was examined at 6 months and 12 months after operation. The complications of two groups were recorded. Results The operation time and hospital- ization time in the observation group [ （ 109.33 ± 30. 39） rain, （ 13.69 ±2.74） d ] were longer than those in the control group [ （78.26 ±22. 69） min, （12. 12 ±2. 27） d] （P 〈0. 05）. The blood loss and blood transfusion volume in the observation group [ （422.57 ± 116. 68） ml, （291.21 ±42. 16） ml] were more than those in the control group [ （171.48 ±95.62） ml, （90. 16±19. 21 ） ml] （P 〈0. 05）. There was no significant difference in postoperative drainage volume between the two groups （P 〉0. 05）. The level of TNF -α and IL - 1 in the observation group were lower than those in the control group at 1 months after the operation （ P 〈 0. 05 ）. At 6 months after operation, there was no significant difference in the excellent rate of hip function between the two groups （P 〉 0. 05 ）. At 12 months after operation, the excellent rate of hip function in the observation group （88.37%） was higher than that in the control group （6

关 键 词：股骨颈骨折 人工股骨头置换术 全髋关节置换术 疗效 预后 

分 类 号：R687.4[医药卫生—骨科学]