半关节置换术和内固定术治疗老年未移位型股骨颈骨折的疗效  

Efficacy of hemiarthroplasty and internal fixation in the treatment of undisplaced femoral neck fractures in the elderly

作　　者：杨浩[1] 宋瑞鹏[1] 王玉强[1] 朱忠培[1] 张杨[1] 陈毅 刘子汭 赵亮[1] Yang Hao;Song Ruipeng;Wang Yuqiang;Zhu Zhongpei;Zhang Yang;Chen Yi;Liu Zirui;Zhao Liang(Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中华实验外科杂志》2022年第4期758-760,共3页Chinese Journal of Experimental Surgery

摘　　要：目的探讨半关节置换术和内固定术治疗老年未移位型股骨颈骨折的临床疗效。方法2016年6月至2019年6月于郑州大学第一附属医院住院接受手术治疗的老年未移位型股骨颈骨折患者72例,半关节置换组35例和内固定组37例。对比两组患者的手术时间、术中出血量、住院时间、再手术率、术后并发症情况;使用Harris评分评价两种术式的髋关节功能改善情况。定性数据之间的比较采用χ^(2)检验,计量资料组内不同时间点间的比较采用单因素方差分析,相同时间点两组间的比较采用t检验。结果72例患者均顺利完成手术,内固定组在手术时间[(43.6±6.9)min]、出血量[(59.4±13.2)ml]、住院时间[(10.2±2.1)d]方面均明显少于半关节置换组[手术时间(73.9±8.8)min(t=-16.234,P<0.05)、出血量(296.1±19.5)s(t=-60.643,P<0.05)、住院时间(14.9±1.6)d(t=-10.645,P<0.05)],差异有统计学意义。内固定组并发症总发生率[40.5%(15/37)]明显高于半关节置换组[17.1%(6/35),χ^(2)=4.766,P<0.05],差异有统计学意义。半关节置换组再手术率[2.9%(1/35)]明显低于内固定组[21.6%(8/37),χ^(2)=5.790,P<0.05],差异有统计学意义。术后6个月,半髋关节置换组髋关节Harris评分优良率[68.6%(24/35)]优于内固定组[40.5%(15/37),χ^(2)=5.692,P<0.05],差异有统计学意义;但在其他随访时间点,两组髋关节功能具有相似改善效果。结论对于老年未移位型股骨颈骨折患者来说,虽然内固定组患者的手术时间短、出血量少、住院时间短,但半关节置换术具有术后总并发症少、再手术率低、早期功能恢复好等优点。在远期功能恢复方面,两者具有相似的疗效。研究结果表明,对某些患者来说,半关节置换术可能是一种更好的选择。Objective To investigate the clinical efficacy of hemiarthroplasty and internal fixation in the treatment of undisplaced femoral neck fractures in the elderly.Methods Totally,72 elderly patients with undisplaced femoral neck fractures who were hospitalized at the First Affiliated Hospital of Zhengzhou University for surgical treatment from June 2016 to June 2019 were grouped:35 in the hemiarthroplasty group and 37 in the internal fixation group.The operative time,intraoperative bleeding,hospital stay,reoperation rate,and postoperative complications were compared between the two groups;the improvement of hip function was evaluated using the Harris score for both procedures.Theχ^(2) test was used for comparison between qualitative data,and one-way ANOVA was used for comparison between different time points within the measurement data groups,and t-test was used for comparison between two groups at the same time point.Results All 72 patients completed the surgery successfully,and the internal fixation group had significantly shorter operative time[(43.6±6.9)min],less bleeding volume[(59.4±13.2)ml],shorter and hospital stay[(10.2±2.1)d]than the hemiarthroplasty group[operative time(73.9±8.8)min(t=-16.234,P<0.05),bleeding volume(296.1±19.5)s(t=-60.643,P<0.05),and hospitalization time(14.9±1.6)d(t=-10.645,P<0.05)],and the differences were statistically significant.The overall complication rate in the internal fixation group[40.5%(15/37)]was significantly higher than that in the hemiarthroplasty group[17.1%(6/35),χ^(2)=4.766,P<0.05].The reoperation rate in the hemiarthroplasty group[2.9%(1/35)]was significantly lower than that in the internal fixation group[21.6%(8/37),χ^(2)=5.790,P<0.05].At 6 months postoperatively,the rate of excellent hip Harris score in the hemiarthroplasty group[68.6%(24/35)]was higher than that in the internal fixation group[40.5%(15/37),χ^(2)=5.692,P<0.05].However,at other follow-up time points,the two groups had similar improvement in hip function.Conclusion For elderly patients with un

关 键 词：半关节置换术 内固定术 未移位型股骨颈骨折 髋关节功能 

分 类 号：R687.3[医药卫生—骨科学]