【摘要】 目的采用前瞻性随机对照研究方法比较空心钉内固定、股骨头置换和全髋关节置换术治疗老年移位型股骨颈骨折的临床疗效及安全性。方法 2007年1月—2014年11月收治符合选择标准的老年移位型股骨颈骨折患者113例。采用随机数字表法分成3组,空心钉内固定术组38例,股骨头置换术组35例和髋关节置换术组40例。记录3组患者手术时间、术中出血量、术后卧床时间、住院时间、住院费用、术后并发症、再次手术率、死亡率及术后1年、3年行髋关节功能Harris评分,评价术后疗效。结果空心钉内固定术组手术时间、术中出血量、术后卧床时间、住院时间、住院费用与股骨头置换术组和全髋关节置换术组比较,差异有统计学意义(P<0.05),股骨头置换术组手术时间、术中出血量和住院费用低于全髋关节置换术组(P<0.05)。3组术后均获得随访,随访时间为3年。空心钉内固定术组早期并发症发生率21.05%、股骨头置换术组8.57%、全髋关节置换术组7.50%,晚期并发症发生率分别为31.57%,14.29%和9.09%,再次手术率为18.42%,8.57%,5.00%;空心钉内固定术组早晚期并发症发生率、再次手术率高于股骨头置换术组和全髋关节置换术组,差异有统计学意义(P<0.05);股骨头置换术组和全髋关节置换术组间差异无统计学意义(P>0.05)。术后1年,3组髋关节功能Harris评分,空心钉内固定术组优良率52.56%,股骨头置换术组86.59%,全髋关节置换术组为87.50%;术后3年,3组髋关节功能Harris评分优良率分别为44.73%,62.86%,85.00%。术后1年、3年空心钉内固定术组髋关节功能Harris评分优良率与股骨头置换术组和全髋关节置换术组比较,差异有统计学意义(P<0.05)。结论对于老年移位型股骨颈骨折,临床上更倾向全髋关节置换术。如果患者年龄、预期寿命、骨折类型、骨质条件、功能要求、全身健康状况以及经济条件允许,相对于空心钉内固定和股骨头置换术,全髋关节置换术是较好的手术选择。更多还原

【Abstract】 Objective To compare the effectiveness and safety of hollow nail internal fixation,femoral head replacement and total hip replacement in the treatment of elderly patients with displaced femoral neck fractures. Methods Between November and 2014 January 2007.113 cases of displaced femoral neck fracture were randomly divided into 3 groups.After reduction,fractures was fixed with hollow nail internal fixation in 38 cases,with femoral head replacement in 35 cases and with total hip replacemen tin 40 cases.The operative time,intraoperative blood loss,postoperative bed time,hospitalization time,hospitalization expenses,postoperative complications,reoperation rate,mortality rate and Harris score of hip function in 1 and 3 years postoperatively were compared between the 3 groups. Results There were significant differences in the operative time,intraoper-ative blood loss,postoperative bed time,hospitalization time and hospitalization expenses among 3 groups(P<0.05),and hollow nail internal fixation group was less than other 2 groups.The operation time,bleeding volume and hospitalization the cost in the femoral head replacement group is lower than the total hip arthroplasty group(P<0.05).All patients were followed up and the follow-up time was 3 years.In hollow nail internal fixation group,femoral head replacement group,and total hip arthroplasty group.The incidence of early complications were 21.05%%,8.57%,7.50% respectively.the incidence of late complications were 31.57%,14.29% and 9.09%,respectively.and the reoperation rate were18.42%,8.57%and 5.00%,respectively.The early and late complications and reoperation rate were significantly higher in hollow screw fixation group than in femoral head replacement group and total hip replacement group(P<0.05).but there was no statistically significant difference bewteen femoral head replacement group and total hip arthroplasty group(P>0.05).1 years after the operation,according to hip Harris score,the excellent and good rate were 52.56%,86.59%,87.50%in hollow screw fixation group,femoral head replacement group and total hip replacement group,respectively.3 years after the operation,the excellent and good rate were 44.73%,62.86%,85.00% in hollow screw fixation group,femoral head replacement group and total hip replacement group,respectively.Showing significant differences among 3 groups(P<0.05).Conclusion Total hip arthroplasty is more clinically effective than hollow nail internal fixation and femoral head replacement in the elderly patients with displaced femoral neck fracture of hip.According to the patient’s age,life expectancy,bone type,condition,function requirements,general health and economic conditions with respect to the fractures,Total hip arthroplasty is a reasonable choice for the patients with displaced femoral neck fractures.更多还原