老年移位性股骨颈骨折手术方案的选择

摘要

目的：比较老年人移位股骨颈骨折Ⅰ期行人工全髋关节置换（Total hip replacement，THR）与内固定失效后再行THR疗效，探讨老年人移位股骨颈骨折的治疗方法。方法将2006年1月至2012年12月因内固定失效后行THR 22例老年移位股骨颈骨折纳入观察组，同期因移位股骨颈骨折Ⅰ期行THR的老年患者30例纳入对照组，观察并比较两组患者的手术时间、术中出血量、Harris评分及卡氏生活质量评分。结果所有患者均成功随访，两组各有1例患者死亡，两组患者均未发生关节感染、翻修等严重并发症。观察组THR手术时间[(114.82±32.13) min]高于对照组[(90.63±16.24) min]，其差异有统计学意义(P<0.05)；观察组THR术中出血量[(551.73±241.62) ml]高于对照组[(314.46±156.72) ml]，其差异具有显著的统计学意义(P<0.05)；观察组术后随访时的Harris评分[(88.24±6.71)分]与对照组[(91.52±6.24)分]比较差异无统计学意义(P>0.05)；观察组术后随访时的卡氏生活质量评分[(94.62±0.85)分]与对照组[(96.03±0.76)分]比较差异无统计学意义(P>0.05)。结论Ⅰ期行THR手术治疗老年人移位股骨颈骨折风险低于内固定失效后再行THR，是临床治疗老年移位性股骨颈骨折较优的治疗选择。%Objective To compare the clinical effects of primary total hip replacement (THR) and secondary THR after failed internal fixation in the elderly patients with displaced femoral neck fracture so as to investigate the optimal treatment for displaced femoral neck fractures in the elderly patients. Methods Twenty-two patients treated with secondary THR after failed internal fixation between January 2006 and December 2012 were in observation group and 30 cases treated with primary THR were in control group. The data of each group were recorded separately, and operation time, blood loss, postoperative Harris scores for hip joint and health-related quality of life (KPS score) were observed and analyzed. Results Both of the groups were followed up successfully. Each group has one patient died, and there were no joint infection, re-operations or any other complications in both of the groups. Operative duration of observation group [(114.82 ± 32.13) min] was longer than operative duration in control group [(90.63 ± 16.24) min]. There was statistically significant difference (P<0.05). Blood loss of observation group [(551.73±241.62) ml] was more than that in control group [(314.46 ± 156.72) ml]. There was statistically significant difference (P<0.05). At follow up, there was no statistically significant difference in Harris score between observation group (88.24 ± 6.71) and control group (91.52±6.24), (P>0.05). There was also no statistically significant difference in KPS score between observation group (94.62 ± 0.85) and control group (96.03 ± 0.76), P>0.05. Conclusion The primary THR for displaced femoral neck fracture in elderly patient showed lower risk in the operation compared with the secondary THR after failed inter-nal fixation. THR is an optimal treatment for displaced femoral neck fractures in the elderly patients.