人工股骨头置换术和人工全髋关节置换术治疗高龄股骨颈骨折的临床疗效分析

Clinical efficacy of artificial femoral head replacement or total hip replacement for treating femur neck fracture in aged patients

摘要:

目的： 探究采用人工股骨头置换术和人工全髋关节置换术治疗高龄股骨颈骨折患者（年龄≥75岁）的临床疗效。方法： 回顾2014年1月至2018年1月140例行人工髋关节置换术的高龄股骨颈骨折（年龄≥75岁）患者资料，其中采用人工股骨头置换术的患者70例，设为A组；采用人工全髋关节置换术的患者70例，设为B组。比较2组患者术前、术后第3天视觉模拟评分法（visual analogue scale，VAS）疼痛评分、手术时间、术中出血量、术后首次下床行功能锻炼时间、术后住院时间、术后并发症情况，以及置换后1周、3个月、6个月、12个月、18个月髋关节功能Harris评分等。结果： 2组患者术前VAS疼痛评分与术后第3天相比，术后疼痛均明显减低，均具有统计学意义；A组患者在手术时间、术中出血量、术后住院时间、术后首次下床行功能锻炼时间方面较B组有优势，差异具有统计学意义；A组患者在术后第3天VAS疼痛评分及置换后1周的髋关节功能Harris评分，效果优于B组，具有统计学意义；2组患者置换后3个月、6个月髋关节功能Harris评分效果相同，无统计学差异；术后12个月、18个月随访，B组患者髋关节功能Harris评分方面优于A组，差异具有统计学意义。结论： 对于高龄股骨颈骨折患者（年龄≥75岁），2种手术方式术后均能迅速缓解髋关节疼痛，恢复髋关节功能，显著提高患者生活质量。其中人工股骨头置换术具有相对创伤小、手术时间短、术中失血少等优点，适合术前一般情况较差且对术后功能要求不高的高龄患者。而对于既往体质相对良好的高龄患者，在经过充分的术前评估准备后，优先选择人工全髋关节置换术。

Abstract:

Objective: To explore the clinical efficacy of artificial femoral head replacement and total hip replacement in the treatment of aged patients (aged≥75 years) with femoral neck fracture. Methods: The clinical data of 140 aged patients (aged≥75 years) with femoral neck fracture who underwent artificial hip replacement during January 2014 to January 2018 were retrospectively analyzed, among which 70 patients who underwent artificial femoral head replacement were divided into group A, and 70 patients who underwent artificial total hip replacement were divided into group B. The pain scores of visual analogue scale (VAS), operation time, intraoperative blood loss, the first time for off-bed activity after operation, postoperative hospital stay, postoperative complications, and Harris scores of hip joint activities in 1 week, 3 months, 6 months, 12 months and 18 months after operation in patients of these 2 groups were compared and analyzed. Results: The VAS scores of the two groups 3 days after operation were significantly lower than those before operation. The operating time, intraoperative blood loss, postoperative hospital stay, the time for off-bed activity after operation in patients of group B were significantly higher than those of patients in group A. And Harris scores of hip joint activities in 1 week, VAS after operation in patients of group A were significantly better than those of patients in group B. There was no significant difference in Harris scores of hip joint activities in 3 and 6 months in patients of these two groups. After follow-up for 12 and 18 months, Harris scores in patients of group B were significantly better than those of patients in group A. Conclusion: For the aged patients (aged≥75 years) with femoral neck fracture, the two kinds of operation can quickly relieve the pain of hip joint, recover the function of hip joint earlier, and improve the quality of life of patients significantly. Artificial femoral head replace-ment with shorter operation time and less bleeding is suitable for aged patients with poor physical conditions, less activities before injury and low requirement on hip joint function. Total hip replacement should be the first choice for aged patients with better physical conditions after sufficient preparation.