人工全髖關節置換術與采用空心加壓螺紋釘內固定術治療老年股骨頸骨折的效果比較

王小剛+吳衛國+朱云龍

【摘要】 目的 比較人工全髖關節置換術與采用空心加壓螺紋釘內固定術治療老年股骨頸骨折的效果。方法 80例老年股骨頸骨折患者， 按照手術方式的不同將其分為關節置換組（42 例）和內固定組（38例）。關節置換組患者采用人工全髖關節置換術治療；內固定組患者采用空心加壓螺紋釘內固定術治療。比較兩組患者術后臥床時間、住院費用、手術時間和手術輸血量， 記錄兩組患者術后3、6、12 個月 Harris 髖關節功能評分， 分析兩組患者術后 1 年并發癥發生情況。結果 關節置換組手術時間為（95.37±21.18）h， 明顯長于內固定組的（68.28±16.51）h；手術輸血量為（560.48±43.53）ml， 明顯多于內固定組的（100.73±17.84）ml；術后臥床時間為（3.87±0.27）d， 明顯短于內固定組的（42.45±5.23）d；住院費用為（35758.89±7692.98）元， 明顯高于內固定組的（13276.23±2007.78）元；差異均有統計學意義（P<0.05）。關節置換組患者術后3、6個月Harris 髖關節功能評分均高于內固定組， 差異有統計學意義（P<0.05）；兩組患者術后12個月Harris 髖關節功能評分比較差異無統計學意義（P>0.05）。術后隨訪 1 年， 關節置換組患者并發癥發生率為7.1%， 明顯低于內固定組的23.7%， 差異有統計學意義（P<0.05）。結論 對于老年股骨頸骨折患者， 人工全髖關節置換術與空心加壓螺紋釘內固定術各有優勢， 應根據患者的客觀具體情況以及主觀需求進而采用不同的術式， 同時完善圍手術期全面評估及治療能最大程度地提高患者髖關節功能， 改善預后， 減少術后并發癥的發生。

【關鍵詞】 人工全髖關節置換術；空心加壓螺紋釘內固定術；老年股骨頸骨折

DOI：10.14163/j.cnki.11-5547/r.2017.29.007

【Abstract】 Objective To compare the effect of artificial total hip replacement and hollow compression screw internal fixation in the treatment of elderly femoral neck fractures. Methods A total of 80 elderly patients with femoral neck fractures were divided by different surgical methods into hip replacement group （42 cases） and internal fixation group （38 cases）. Hip replacement group was treated with artificial total hip replacement， and internal fixation group was treated with hollow compression screw internal fixation. Comparison were made on postoperative bedtime， hospitalization costs， operative time and surgical blood transfusion volume， and record were made on Harris hip function score in postoperative 3， 6 12 months. The occurrence of complications in postoperative 1 year between two groups was analyzed. Results Hip replacement group had obviously longer operation time as （95.37±21.18） h than （68.28±16.51） h in internal fixation group， obviously more surgical blood transfusion volume as （560.48±43.53） ml than （100.73±17.84） ml in internal fixation group， obviously shorter postoperative bedtime as （3.87±0.27） d than （42.45±5.23） d in internal fixation group， and obviously higher hospitalization costs as （35758.89±7692.98） yuan than （13276.23±2007.78） yuan in internal fixation group. Their difference was statistically significant （P<0.05）. Hip replacement group had higher Harris hip function score in postoperative 3， 6 months than internal fixation group， and the difference was statistically significant （P<0.05）. Both groups had no statistically significant difference in Harris hip function score in postoperative 12 months （P>0.05）. In 1 year of follow-up after operation， hip replacement group had obviously lower incidence of complications as 7.1% than 23.7% in internal fixation group， and the difference was statistically significant （P<0.05）. Conclusion For elderly patients with femoral neck fracture， both artificial total hip arthroplasty and hollow compression screw internal fixation have its advantages. Different surgical modes should be selected according to objective conditions and subjective needs. Perfect perioperative comprehensive assessment and treatment can maximally improve the patient's hip function， improve their prognosis and reduce the incidence of postoperative complications.endprint

【Key words】 Artificial total hip replacement； Hollow compression screw internal fixation； Elderly femoral neck fractures

隨著人口老齡化， 股骨頸骨折是威脅老年人健康的一種常見骨外科病癥[1]。北京市豐臺中西醫結合醫院地處北京市西南五環城鄉結合處， 醫院骨科作為豐臺區老年骨科中心每年住院患者中40%為老年患者， 根據老年患者體質特點， 在發生股骨頸骨折后制定個性化的治療方案， 對老年股骨頸骨折患者尤為重要[2]。藥物保守治療、空心加壓螺紋釘固定術及半髖或全髖關節置換術是臨床上治療股骨頸骨折的主要

3種方式[3]。……