中年人移位型股骨颈骨折内固定与关节置换的疗效比较  

Comparison of effect between internal fixation and total hip replacement in the treatment of displaced femoral neck fracture in middle age patients

作　　者：王志远[1] 罗璠 张英琪[1] 刘嘉 祝晓忠[1] 饶志涛[1] WANG Zhi-yuan;LUO Fan;ZHANG Ying-qi;LIU Jia;ZHU Xiao-zhong;RAO Zhi-tao(Department of Orthopaedics,Tongji Hospital of Tongji University,Shanghai200065,China)

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《中国骨伤》2023年第3期232-235,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:分析比较年龄55~65岁中年人股骨颈移位型骨折内固定与关节置换的临床疗效。方法:2016年9月至2020年8月收治GardenⅢ型或Ⅳ型股骨颈骨折患者86例,根据手术方式的不同将其分为两组。其中38例采用平行拉力螺钉内固定治疗(内固定组),男26例,女12例,年龄55~64(60.2±3.1)岁;48例进行全髋关节置换术(关节置换组),男28例,女20例,年龄57~65(61.3±3.8)岁。受伤至手术时间1~3 d。比较两组患者的再手术率,深部感染发生率,髋关节功能Harris评分,疼痛视觉模拟评分(visual analogue scale,VAS),患者主观报告功能评分采用欧洲五维健康量表(European five-dimensional Health Questionnaire,EQ-5D)。结果:所有患者获得随访,时间24~54(35.8±10.3)个月。平行拉力螺钉内固定组术后再手术率高于较全髋关节置换术组(P<0.05)。两组患者深部感染发生率比较,差异无统计学意义(P>0.05)。两组患者术后12个月时髋关节Harris评分及VAS比较,差异均无统计学意义(P>0.05)。平行拉力螺钉内固定组术后患者主观报告的功能评分EQ-5D低于全髋关节置换术组(P<0.05)。结论:中年人股骨颈移位型骨折内固定与关节置换的中短期疗效相似,但全髋关节置换术后再手术率低,患者主观报告的功能评分较高。Objective To analyze and compare the clinical efficacy of internal fixation and total hip replacement in the treatment of displaced femoral neck fracture from 55 to 65 years.Methods From September 2016 to August 2020,86 patients with Garden typeⅢorⅣfemoral neck fracture were divided into two groups according to different surgical methods.Among them,38 patients were treated with lag screws for internal fixation,there were 26 males and 12 females,aged 55 to 64 years old with an average of(60.2±3.1)years;the other 48 patients were treated with total hip replacement,including 28 males and 20 females,aged from 57 to 65 years old with an average of(61.3±3.8)years.The time from injury to operation ranged from 1 to 3 days.The reoperation rate,incidence of deep infection,Harris score of hip joint function,visual analogue scale(VAS)of pain and patients reported outcome scores(European five-dimensional Health Questionnaire,EQ-5D)were compared between two groups.Results All patients were followed up for 24 to 54 months with an average of(35.8±10.3)months.There was significant difference in reoperation rate between two groups(P<0.05).There was no significant difference on the incidence of deep infection,hip Harris score and VAS between two groups(P>0.05).The postoperative EQ-5D score of patients with internal fixation was lower than that of total hip replacement,and the difference was statistically significant(P<0.05).Conclusion Both the surgery of internal fixation and total hip replacement have similar effect in short-and medium term among the patients aged 55 to 65 years old.However,for the reoperation rate,the group of internal fixation was higher than that of total hip replacement.For the subjective functional score of patients,the group of internal fixation was lower than that of total hip replacement.

关 键 词：股骨颈骨折 内固定 全髋关节置换术 

分 类 号：R683.42[医药卫生—骨科学]