全髋与半髋关节置换术对股骨颈骨折老年患者的近远期临床疗效  

Short term and long-term clinical effects of total hip arthroplasty and hemiarthroplasty on elderly patients with femoral neck fracture

作　　者：付立新[1] 刘志超 崔彦江[1] 杨克强[1] 苗巍 李新[1] 马子龙 张书钦[1] Fu Lixin;Liu Zhichao;Cui Yanjiang;Yang Keqiang;Miao Wei;Li Xin;Ma Zilong;Zhang Shuqin(Department of Orthopedics(Ⅰ),South District of Guang′anmen Hospital,Chinese Academy of Traditional Chinese Medicine,Beijing 102600,China)

机构地区：[1]中国中医科学院广安门医院南区骨一科,北京102600

出　　处：《中国医师杂志》2021年第6期878-881,共4页Journal of Chinese Physician

基　　金：中国中医科学院广安门医院南区院级科研基金(Y2020-09)。

摘　　要：目的探讨股骨颈骨折(FNF)老年患者应用全髋关节置换(THA)与半髋关节置换(HA)的临床效果及近远期疗效观察。方法回顾性统计2017年3月至2019年1月广安门医院南区收治的老年FNF患者59例,观察组(n=29)采用THA治疗;对照组(n=30)采用HA治疗。比较观察两组患者手术相关指标、术后近远期的临床效果(出院患者平均随访24.1个月)、髋关节功能改善情况、疼痛以及并发症等。近远期临床效果评价:通过随访2组患者术后第1、3、6、9、12个月的HHS评分(Harris Hip Score)以观察2组患者术后近远期临床效果。结果THA和HA对老年FNF均有效,但THA有效率(96.6%)明显高于HA(90.0%),差异有统计学意义(P<0.05);手术相关指标方面,THA手术时间[(104.46±3.24)min]较HA[(84.34±3.64)min]长,术中出血量[(296.64±15.16)ml]较HA[(281.44±12.16)ml]多,术后引流量[(101.24±4.15)ml]较HA[(74.56±3.24)ml]多,但通过HHS表对比THA术后功能恢复优于HA(P<0.05);THA术后并发症发生率较HA降低(P<0.05),疼痛较HA显著减轻(P<0.05)。结论THA并发症低,功能恢复快,效果更佳。临床应结合患者身体情况决定,对于基础状况较好、手术耐受良好、日常活动较多的老年患者采用THA,对于基础状况不佳、手术耐受较低、日常活动较少的高龄患者采用HA。Objective To investigate the clinical effect and short-term and long-term effect of total hip replacement(THA)and hemiarthroplasty of hip(HA)in elderly patients with femoral neck fracture(FNF).Methods 59 elderly patients with FNF in South District of Guang′anmen Hospital,Chinese Academy of Traditional Chinese Medicine from March 2017 to January 2019 were retrospectively analyzed.The observation group(n=29)was treated with THA;The control group(n=30)was treated with HA.The operation related indexes,short-term and long-term clinical effect(average follow-up of 24.1 months),hip function improvement,pain and complications were compared between the two groups.Short term and long-term clinical effects:the short-term and long-term clinical effects of the two groups were observed by the Harris Hip Score(HHS)of the first month,the third month,the sixth month,the ninth month and the first year after operation.Results Both THA and HA were effective on elderly FNF,but the effective rate of THA(96.6%)was significantly higher than that of HA(90.0%),with statistically significant difference(P<0.05);in terms of operation related indicators,compared with the control group,the observation group had longer operation time[(104.46±3.24)min vs(84.34±3.64)min],more amount of bleeding[(296.64±15.16)ml vs(281.44±12.16)ml],lower postoperative drainage volume[(101.24±4.15)ml vs(74.56±3.24)ml],while the functional recovery of the observation group was better than the control group by HHS(P<0.05);the postoperative complications and HHS score of observation group were significantly lower than the control group(P<0.05).Conclusions THA has the advantages of low complication,fast functional recovery and better effect.The clinical decision should be based on the patient′s physical condition.THA should be used for elderly patients with good basic condition,good surgical tolerance and more daily activities.HA should be used for elderly patients with poor basic condition,low surgical tolerance and less daily activities.

关 键 词：股骨颈骨折 关节成形术 置换 髋 老年人 

分 类 号：R687.3[医药卫生—骨科学]