不同髋关节置换术式治疗老年髋关节骨折内固定失败患者的临床效果及对髋关节功能的影响  

Clinical Effects of Different Surgical Procedures for Hip Replacement in the Treatment of Elderly Patients with Failed Internal Fixation of Hip Fracture and Their Impact on Hip Joint Function

作　　者：潘恒[1] 宋雄英 李公[1] PAN Heng;SONG Xiongying;LI Gong(Department of Bone and Joint,Fengtai Hospital,Fengtai District,Beijing 100000,China)

机构地区：[1]北京丰台医院骨关节科,北京100000

出　　处：《临床误诊误治》2025年第3期67-72,共6页Clinical Misdiagnosis & Mistherapy

基　　金：北京丰台医院院级科学研究项目(2022-10)。

摘　　要：目的比较不同髋关节置换术式治疗老年髋关节骨折内固定失败患者的临床效果。方法回顾性分析2012年1月至2022年1月收治的老年髋关节骨折内固定失败患者80例的临床资料,根据手术方案分为对照组39例和观察组41例。对照组采用半髋关节置换术,观察组采用全髋关节置换术。比较2组临床指标、Harris髋关节评分、临床疗效、骨代谢生化指标[骨碱性磷酸酶(BALP)、骨钙素、Ⅰ型前胶原氨基端原肽(PⅠNP)以及抗酒石酸性磷酸酶(TRACP-5b)],统计2组术后并发症发生情况。结果80例患者均成功完成手术及随访,随访时间(6.16±0.38)个月。观察组手术时间、下床活动时间长于对照组,术中失血量多于对照组(P<0.05)。随着术后时间延长,2组Harris髋关节评分呈上升趋势,且术后1、3、6个月,观察组高于对照组(P<0.05)。术后6个月,观察组总优良率[95.12%(39/41)]高于对照组[79.49%(31/39)],差异有统计学意义(P<0.05)。术后6个月,2组BALP、骨钙素、PⅠNP水平升高,TRACP-5b水平降低,且观察组BALP、骨钙素、PⅠNP水平高于对照组,TRACP-5b水平低于对照组(P<0.05,P<0.01)。2组并发症发生率比较差异无统计学意义(P>0.05)。结论全髋关节置换术治疗老年髋关节骨折内固定失败患者较半髋关节置换术临床疗效显著、骨代谢能力更佳,且不增加并发症发生风险。Objective To compare the clinical effect of different surgical procedures for hip replacement in the treatment of elderly patients with failed internal fixation of hip fracture.Methods Clinical data of 80 elderly patients with failed internal fixation of hip fracture admitted to Department of Surgery of our hospital from January 2012 to January 2022 were retrospectively analyzed.They were divided into the control group(undergoing half hip replacement,n=39)and the observation group(undergoing total hip replacement,n=41)according to different surgical plans.The clinical indexes,Harris hip score,clinical efficacy,and biochemical indexes of bone metabolism[bone alkaline phosphatase(BALP),bone glaprotein(BGP),procollagenⅠN-terminal propeptide(PⅠNP)and tartrate-resistant acid phosphatase 5b(TRACP-5b)]were compared between the two groups,and the incidence of postoperative complications was calculated between the two groups.Results All the 80 patients were successfully operated and followed up for a mean of(6.16±0.38)months.The duration of operation and the time to off-bed activity of observation group were longer than those of control group,and the intraoperative blood loss was greater than that of control group(P<0.05).With the extension of postoperative time,the Harris hip score of the two groups showed an increasing trend,which was higher in the observation group than in the control group at 1,3 and 6 months after operation(P<0.05).At 6 months after operation,the overall excellent and good rate of the observation group[95.12%(39/41)]was higher than that of the control group[79.49%(31/39)],suggesting significant differences(P<0.05).At 6 months after operation,the levels of BALP,BGP and PⅠNP in the two groups increased,and the levels of TRACP-5b decreased;the levels of BALP,BGP and PⅠNP in observation group were higher than those in control group,while the levels of TRACP-5b were lower than those in control group(P<0.05,P<0.01).There was no significant difference in the incidence of complications between the t

关 键 词：关节成形术 置换 髋 髋关节骨折内固定失败 Harris髋关节评分 骨碱性磷酸酶 骨钙素 Ⅰ型前胶原氨基端原肽 抗酒石酸性磷酸酶 手术后并发症 

分 类 号：R687.42[医药卫生—骨科学]