【摘要】 [目的]对比空心钉内固定术(internal fixation,IF)与人工股骨头置换术(hemiarthroplasty,HA)治疗老年移位型股骨颈骨折的手术疗效和费用。[方法]收集2011年1月~2011年12月于本院接受治疗的135例老年移位型股骨颈骨折患者资料,其中接受IF患者62例,接受HA患者73例。比较两组患者手术相关指标、住院天数、并发症、死亡率等情况。采用髋部骨折功能恢复量表(functional recovery scale,FRS)和欧洲五维健康量表(EQ-5D)评估患者髋部功能和生活质量。末次随访时估算患者骨折相关住院费用。[结果]所有患者均顺利完成手术并完成3年随访。IF组患者术中出血量、手术时间、住院天数均明显低于HA组(P<0.05)。IF组并发症发生率高于HA组(P<0.05)。两组患者3年内死亡率差异无统计学意义(P>0.05)。术后1年FRS评分HA组优于IF组,术后3年时两组差异无统计学意义(P>0.05)。术后各随访时间两组患者EQ-5D评分差异无统计学意义(P>0.05)。3年内两组骨折相关住院费用分别为31 611元和54 644元(P<0.05)。[结论]空心钉内固定与人工股骨头置换术是治疗老年移位型股骨颈骨折的有效方法,均能有效改善患者生活质量,HA有助于短期内提高患者髋部功能。与HA相比虽然IF并发症发生率较高,但其创伤小、出血少、治疗费用相对低廉。更多还原

【Abstract】 [Objective]To compare the clinical outcomes of internal fixation( IF) and hemiarthroplasty( HA) for displaced femoral neck fracture in the elderly. [Method]A total of 135 patients with displaced femoral neck fracture from January2011 to December 2011 were included in this retrospective study. Patients were divided into IF and HA groups( n = 62 /73 respectively). The clinical indicators including amount of blood loss,duration of hospitalization,complications and death rate were compared between the 2 groups. The clinical outcomes were evaluated with functional recovery scale for hip fracture( FRS) and EQ- 5D index. At the last follow- up,the medical cost related to fracture was caculated.[Result]All the patients completed the operation successfully and were followed up for 3 years. The amount of intraoperative blood loss,operation time and hospital stay were less in IF group while the complication rate in IF group was higher. The death rate were similar between the two groups. FRS scores were higher in HA group than in IF group at 1 year after surgery,while were similar between the two groups at the last follow- up. EQ- 5D scores showed no significant difference between the 2 groups at each follow- up time point( P > 0. 05). The medical expense cost for IF group and HA group was CNY 31611 and CNY 54644( P < 0. 05),respectively. [Conclusion]Both internal fixation and hemiarthroplasty are effective treatments for displaced femoral neck fracture in the elderly but HA can provide early hip functional recovery. Although the complication rate is higher in IF group compared with HA treatment,the medical cost is lower with less trauma.更多还原