全髋关节置换术与骨折内固定术治疗老年移位型股骨颈骨折的临床效果

李漌涼　李章华

[摘要] 目的 比較全髋关节置换术与骨折内固定术治疗老年移位型股骨颈骨折的临床效果。 方法 选取2013年10月～2015年8月在湖北省武汉市第三医院诊治的96例老年移位型股骨颈骨折患者，采用随机数字表法分为内固定组及置换组，其中内固定组44例，置换组52例，比较两组手术相关指标（手术时间、术中出血量、住院天数及住院费用），术后早期并发症（压疮、肺部感染、深静脉血栓形成、髋关节脱位）及远期并发症（股骨头缺血坏死、骨不连），术后1个月和12个月的Harris评分、日常生活能力（ADL）评分及世界卫生组织生存质量测定量表（WHO-QOL）评分。 结果 内固定组手术时间、住院天数明显短于置换组，术中出血量、医疗费用明显少于置换组，差异有高度统计学意义（P < 0.01）。内固定组股骨头缺血坏死、骨不连发生率均高于置换组，差异有统计学意义（P < 0.05）。置换组术后12个月的Harris评分、ADL评分、WHO-QOL评分均高于内固定组，差异有统计学意义（P < 0.05）；两组术后12个月的Harris评分、ADL评分、WHO-QOL评分均高于术后1个月，差异有统计学意义（P < 0.05）。 结论 全髋关节置换术患者术后并发症较少，远期肢体功能恢复、ADL及生存质量均明显优于内固定患者，其应作为老年移位型股骨颈患者的首选治疗方式。

[关键词] 全关节置换；内固定；移位型；股骨颈骨折

[中图分类号] R683 [文献标识码] A [文章编号] 1673-7210（2016）12（c）-0112-05

[Abstract] Objective To compare clinical effect of total hip arthroplasty and internal fixation in the treatment of elderly displaced femoral neck fracture. Methods 96 elderly patients with displaced femoral neck fracture treated in the Third Hospital of Wuhan City， Hubei Province from October 2013 to August 2015 were selected. They were divided into internal fixation group and arthroplasty group by randomized number table method. Internal fixation group was 44 cases， arthroplasty group was 52 cases. Operative parameters （operation time， intraoperative blood loss， length of stay and hospitalization expenses）， early postoperative complications （pressure ulcer， pulmonary infection， deep venous thrombosis， hip dislocation） and long term postoperative complications （avascular necrosis of the femoral head， nonunion）， Harris score， the ability of daily living （ADL） score and WHO-QOL score after operation of 1 month and 12 months between two groups were compared. Results Operation time and hospital stay in internal fixation group were significantly shorter than those in arthroplasty group， intraoperative blood loss and medical cost in internal fixation group were significantly less than those in arthroplasty group， the differences were statistically significant （P < 0.01）. The incidence rates of avascular necrosis of femoral head and nonunion in internal fixation group were higher than those in arthroplasty group， the differences were statistically significant （P < 0.05）. Harris score， ADL score and WHO-QOL score in arthroplasty group after operation of 12 months were higher than those in internal fixation group， the differences were statistically significant （P < 0.05）. Harris score， ADL score and WHO-QOL score in two groups after operation of 12 months were higher than after operation of 1 month， the differences were statistically significant （P < 0.05）. Conclusion Total hip arthroplasty has less postoperative complications， recovery of limb function， ADL and quality of life in total hip arthroplasty patients are significantly better than those in patients with internal fixation. It should be the first choice for the treatment of elderly patients with displaced femoral neck.

[Key words] Total hip arthroplasty； Internal fixation； Displacement； Femoral neck fracture

股骨颈骨折是老年人致残及致死的主要原因之一。在所有老年跌倒相关的四肢损伤中，股骨颈骨折所致的死亡人数最多，其带来的严重社会健康问题不可忽视[1]。老年股骨颈骨折的发病为4.65/10万，大约占所有髋部骨折的57%，而占全身骨折的3.3%～3.8%[2-3]。有20%～25%的股骨颈骨折患者在伤后1年死亡，而存活患者中，40%的患者无法独立行走，60%的患者无法独立完成日常活动，需要依赖他人。股骨颈骨折不仅严重危害老年患者的健康，同时给社会带来巨大负担。据估计在美国，2005年髋部骨折占全身骨折的14%，但是因髋部骨折所造成的经济负担占所有骨折医疗开销的72%[4]。……