老年股骨颈骨折内固定失败后挽救性全髋关节置换术的疗效观察  

The surgical results of total hip replacement after internal fixation failure for displaced femoral neck fracture in the elderly patients

作　　者：耿成武 王飞 张继超 田忠固 张腾 苏永刚[2] Geng Chengwu;Wang Fei;Zhang Jichao;Tian Zhonggu;Zhang Teng;Su Yonggang(Second Department of Orthopedics,Beijng Pinggu Chinese Medical Hospital,Beijing 101200,China;Department of Orthopedics and Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京市平谷中医医院骨伤二科,北京101200 [2]北京积水潭医院创伤骨科,北京100035

出　　处：《中国医刊》2020年第7期726-730,共5页Chinese Journal of Medicine

摘　　要：目的探讨老年股骨颈骨折内固定失败后行挽救性全髋关节置换(total hip replacement,THR)的临床疗效。方法选取2015年6月至2017年8月北京积水潭医院和北京市平谷中医医院收治的86例老年股骨颈骨折患者,其中32例一期行THR(THR组),31例一期行空心钉内固定(内固定组),23例内固定失败后行挽救性THR(翻修组)。记录三组患者的手术时间、围术期失血量、术后并发症发生情况等并进行组间比较。术后6个月、1年及2年采用髋部骨折功能恢复量表(functional recovery scale,FRS)评估患者关节功能,采用欧洲五维健康量表(Euro-quality of life-5 dimension,EQ-5D)评估患者生活质量。术后2年采用疼痛视觉模拟量表(visual analogue scale,VAS)评估髋部/股部疼痛程度。结果翻修组的手术时间长于THR组和内固定组,围术期总失血量多于内固定组,且THR组手术时间长于内固定组,围术期总失血量多于内固定组,差异均有显著性(P<0.05)。三组术后并发症发生率差异无显著性(P>0.05)。术后6个月、1年及2年时THR组的FRS评分和EQ-5D指数均明显优于翻修组和内固定组(P<0.05),而翻修组与内固定组比较差异无显著性(P>0.05)。术后2年时三组VAS评分比较差异无显著性(P>0.05)。结论THR和空心钉内固定均是治疗老年股骨颈骨折的有效方法,内固定失败后再次行THR虽能有效改善患者的关节功能和生活质量,但总体疗效相对较差。Objective To compare the clinical effect of total hip replacement(THR),internal fixation(IF)and revision total hip replacement after IF failure for displaced femoral neck fracture in the elderly patients.Method The data of 86 elderly patients with displaced femoral neck fracture were collected in this study from June 2015 to August 2017.There were 31 cases in IF group,32 cases in THR group and 23 cases in revision group according to the surgery type.The factors such as operation time,blood loss,and complication rate were compared.All the patients were followed up for 2 years periodically.The hip function and quality of life were evaluated by functional recovery scale(FRS)and EQ-5D index respectively.Result The amount of bleeding,operation time was higher in revision group while the complication rate was similar for the 3 groups.At the last follow-up the FRS scores and EQ-5D index favored THR obviously(P<0.05).Although the clinical outcome of IF is better than that of revision THR,there is no statistical difference(P>0.05).Conclusion Both total hip replacement and internal fixation are effective surgery for elderly patients with displaced femoral neck fracture.For the failure after internal fixation THR can improve the quality of life effectively,but the clinical outcome were less desirable.

关 键 词：股骨颈骨折 骨折固定术 内 关节成形术 置换 髋 临床疗效 

分 类 号：R683.42[医药卫生—骨科学]