华西医学

华西医学

老年移位型股骨颈骨折内固定失败后二期全髋关节置换对比初次全髋置换早期临床疗效分析

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目的 对比老年移位型股骨颈骨折采用内固定术后失效二期全髋关节置换与初次全髋关节置换术后的早期临床效果,探究老年移位型股骨颈骨折的最佳治疗方案。 方法 回顾性分析 2011 年 1 月—2015 年 1 月 300 例老年移位型股骨颈骨折患者,其中 150 例采用初次全髋关节置换术,150 例采用内固定失效后二期全髋关节置换术;评估两组患者手术时间、术中出血量、术后引流量、术后下床时间、术后住院时间、术后并发症发生率、术后髋关节功能评分。 结果 与二期置换组相比,初次置换组手术时间更短[(54.7±15.3) vs.(70.1±23.4)min],出血量更少[(116.9±35.0) vs.(131.7±44.5)mL],术后下床时间更早[(1.0±0.3) vs.(1.8±0.6)d],住院时间更短[(12.0±2.9) vs.(15.2±3.1)d],差异均有统计学意义(P<0.05),但术后并发症发生率及术后 3、6、12、24 个月 Harris 评分差异无统计学意义(P>0.05)。 结论 股骨颈骨折二期全髋关节置换手术难度增大,住院时间延长,但早期临床疗效与股骨颈骨折初次全髋关节置换相当。

Objective To compare the short-term clinical outcomes of secondary total hip arthroplasty (THA) after failure of internal fixation with primary THA in elderly patients with displaced femoral neck fractures, and explore the best treatment for displaced femoral neck fractures in the elderly. Methods A total of 300 elderly patients with displaced femoral neck fractures from January 2011 to January 2015 were retrospectively enrolled in this study, of whom 150 underwent primary THA and 150 underwent secondary THA after failure of internal fixation. The operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative ambulation time, length of postoperative hospitalization, incidence of postoperative complications, and score of postoperative hip joint function were compared between the two groups. Results Compared with those in the secondary THA group, in the primary THA group, the operation time was shorter [(54.7±15.3) vs. (70.1±23.4) minutes], the intraoperative bleeding volume was less [(116.9±35.0) vs. (131.7±44.5) mL], the postoperative ambulation was earlier [(1.0±0.3) vs. (1.8±0.6) days], the length of postoperative hospitalization was shorter [(12.0±2.9) vs. (15.2±3.1) days], and the differences were all statistically significant (P<0.05); but there was no statistically significant difference in the incidence of postoperative complications or the Harris scores at 3, 6, 12, and 24 months after operation (P>0.05). Conclusion The secondary THA for femoral neck fracture is more difficult, with longer stay in hospital, but the short-term clinical efficacy is similar to that of the primary THA.

关键词: 老年; 移位型股骨颈骨折; 全髋关节置换; 内固定失效

Key words: Elderly; Displaced femoral neck fracture; Total hip arthroplasty; Failure of internal fixation

引用本文: 斯焱, 韩杰, 张鹏, 张上上, 朱江伟, 李钟, 毕梦娜, 陈经勇, 李箭. 老年移位型股骨颈骨折内固定失败后二期全髋关节置换对比初次全髋置换早期临床疗效分析. 华西医学, 2018, 33(9): 1114-1117. doi: 10.7507/1002-0179.201808027 复制

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