人工股骨头置换与空心螺钉内固定两种术式治疗老年移位型股骨颈骨折的疗效比较  

Comparisons of therapeutic effects between artificial femoral head replacement and cannulated screw internal fixation for displaced femoral neck fracture in the elderly

作　　者：周大方[1] 徐建[1] 纪兆晓 宗浩 王敏[2] ZHOU Dafang;XU Jian;JI Zhaoxiao;ZONG Hao;WANG Min(Department of Orthopaedics,Suqian Workers'Hospital of Jiangsu Province,Suqian,Jiangsu 223800,China;不详)

机构地区：[1]宿迁市工人医院骨科,江苏223800 [2]暨南大学附属广州红十字会医院骨科,广州510220

出　　处：《中国骨科临床与基础研究杂志》2021年第4期153-158,共6页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广州市中医药和中西医结合项目(20202A011011);广州市卫生健康委科技项目西医类一般引导(20211A011021)。

摘　　要：目的对比分析人工股骨头置换(FHA)与空心螺钉内固定(IF)两种术式治疗老年移位型股骨颈骨折(DFNF)的疗效及预后。方法收集2016年3月—2017年10月江苏省宿迁市工人医院医院和暨南大学附属广州红十字会医院需要接受手术治疗的50例DFNF老年患者,采用随机数字表法随机分为FHA组和IF组,每组25例,分别采用FHA和IF术式进行治疗。比较两组围手术期指标及术后生活质量变化。结果与FHA组相比,IF组患者手术时间、术中出血量更少,初次下地时间更长,手术费用和住院总费用更低,术后并发症发生率更高,两组比较,差异均有统计学意义(P<0.05)。FHA组患者1年随访功能恢复量表(FRS)评分高于IF组(P<0.05),2年、3年随访FRS评分无差异(P>0.05);两组随访1、2、3年欧洲五维健康量表(EQ-5D)评分相似(P>0.05)。结论对于DFNF老年患者而言,IF较FHA手术时间短,手术损伤小;FHA能及早恢复患者髋部功能,术后并发症少,但手术费用及住院总费用较高。临床上需根据老年DFNF患者的病情、家庭经济情况和个人意愿,合理选择手术方案。Objective To compare and analyze the efficacy and prognosis of artificial femoral head replacement(FHA)and cannulated screw internal fixation(IF)for displaced femoral neck fracture(DFNF)in the elderly.Methods A total of 50 elderly DFNF patients requiring surgical treatment in Suqian Workers'Hospital of Jiangsu Province and Guangzhou Red Cross Hospital affiliated to Jinan University from March 2016 to October 2017,were enrolled and randomly divided into FHA and IF groups with FHA and IF procedures respectively(n=25).Changes of perioperative indicators and postoperative life quality of patients were compared between two groups.Results Compared with those in FHA group,operation time was shorter,estimate intraoperative blood loss was much less,total hospitalization time was longer,surgical cost and initial treatment cost were lower,and the incidence of postoperative complications was higher in IF group,there were statistically significant between two groups(P<0.05).At 1-year follow-up,functional recovery scale(FRS)score of FHA group was higher than that in IF group(P<0.05),while there were no differences of FRS scores at 2-year and 3-year follow-up between the two groups(P>0.05);European quality of life 5-dimensions(EQ-5D)scores at 1,2 and 3-year follow-up were similar in both groups(P>0.05).Conclusions For elderly patients with DFNF,IF has the advantages of shorter operation time,less surgical damage as well as lower operation cost and total hospitalization cost;While FHA could recover patients'hip functions earlier,and has lower incidence of postoperative complications clinically,the surgical plan should be reasonably selected according to patients'state of illness,family economic situations and individual preferences of elderly DFNF patients.

关 键 词：股骨骨折 骨折固定术 内 关节成形术 置换 髋 股骨头 骨钉 老年人 

分 类 号：R683.421[医药卫生—骨科学] R687[医药卫生—外科学]