全髋与半髋关节置换术治疗老年股骨颈骨折的效果观察
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摘要
目的研讨老年股骨颈骨折患者使用全髋与半髋关节置换术治疗的临床效果。方法以我院收治于2014年4月-2018年7月的64例老年股骨颈骨折患者作为本组课题的实验对象,经随机抽签模式分组,Ⅰ组(n=32)采取全髋关节置换术(THA)治疗,Ⅱ组(n=32)施以半髋关节置换术(HA)治疗,对两组手术的术中出血量、手术时间、引流量、住院时间及术后疗效评价等指标进行比较与评估。结果Ⅰ组及Ⅱ组的手术指标记录显示,Ⅱ组的术中出血量、手术时间、引流量及住院时间比Ⅰ组均具有优势,比较有统计学意义(P<0.05);两组患者优良率比较显示,Ⅰ组93.8%比Ⅱ组75.0%高,比较有统计学意义(P<0.05)。结论老年股骨颈骨折选择THA的术后疗效更好,但HA的术中出血量、手术时间、引流量、住院时间更少,具体术式应结合患者实际情况选择。
Objective To investigate the clinical effects of total hip and hemiarthroplasty in elderly patients with femoral neckfractures. Methods Sixty-four patients with femoral neck fractures from April 2014 to July 18, 2016 were enrolled in this study. Thesubjects were enrolled in the randomized mode. Group I(n=32) underwent total hip arthroplasty. In the treatment of(THA), group II(n=32) was treated with hemiarthroplasty(HA). The intraoperative blood loss, operation time, drainage volume, length of hospital stay,and postoperative evaluation were compared between the two groups. Compare and evaluate. Results The surgical index records ofgroup I and group II showed that the intraoperative blood loss, operation time, drainage volume and hospitalization time of group IIwere superior to group I, which was statistically significant(P<0.05). The comparison of good rate showed that 93.8% of group I was75.0% higher than group II, which was statistically significant(P<0.05). Conclusion The postoperative outcome of THA in elderlyfemoral neck fracture is better, but the intraoperative blood loss, operation time, drainage volume and hospitalization time of HA areless. The specific surgical procedure should be selected according to the actual situation of the patient.
Objective To investigate the clinical effects of total hip and hemiarthroplasty in elderly patients with femoral neckfractures. Methods Sixty-four patients with femoral neck fractures from April 2014 to July 18, 2016 were enrolled in this study. Thesubjects were enrolled in the randomized mode. Group I(n=32) underwent total hip arthroplasty. In the treatment of(THA), group II(n=32) was treated with hemiarthroplasty(HA). The intraoperative blood loss, operation time, drainage volume, length of hospital stay,and postoperative evaluation were compared between the two groups. Compare and evaluate. Results The surgical index records ofgroup I and group II showed that the intraoperative blood loss, operation time, drainage volume and hospitalization time of group IIwere superior to group I, which was statistically significant(P<0.05). The comparison of good rate showed that 93.8% of group I was75.0% higher than group II, which was statistically significant(P<0.05). Conclusion The postoperative outcome of THA in elderlyfemoral neck fracture is better, but the intraoperative blood loss, operation time, drainage volume and hospitalization time of HA areless. The specific surgical procedure should be selected according to the actual situation of the patient.
引文
[1]Bhandari M,Devereaux PJ,Tornetta P,et al.Operative management of displaced femoral neck fractures in elderly patients.An international survey[J].J Bone Joint Surg Am,2005,87(9):2122-30.
[2]Evaniew N,Madden K,Bhandari M.Cochrane in CORR?:Arthroplasties(with and without bone cement)for proximal femoral fractures in adults[J].Clin Orthop Relat Res,2014,472(5):1367-72.
[3]Johnell O,Kanis JA.An estimate of the worldwide prevalence and disability associated with osteoporotic fractures[J].Osteoporos Int,2006,17(12):1726-33.
[4]De Laet CE,Pols HA.Fractures in the elderly:epidemiology and demography[J].Baillieres Best Pract Res Clin Endocrinol Metab,2000,14(2):171-9.
[5]Bergstr?m U,Jonsson H,Gustafson Y,et al.The hip fracture incidence curve is shifting to the right[J].Acta Orthop,2009,80(5):520-4.
[6]Hagino H,Nakamura T,Fujiwara S,et al.Sequential change in quality of life for patients with incident clinical fractures:a prospective study[J].Osteoporos Int,2009,20(5):695-702.
[7]Miyamoto RG,Kaplan KM,Levine BR,et al.Surgical management of hip fractures:an evidence-based review of the literature.I:femoral neck fractures[J].J Am Acad Orthop Surg,2008,16(10):596-607.
[8]Haentjens P,Autier P,Barette M,et al.The economic cost of hip fractures among elderly women.A one-year,prospective,observational cohort study with matched-pair analysis.Belgian Hip Fracture Study Group[J].J Bone Joint Surg Am,2001,83-A(4):493-500.
[9]Kanlic E,Cruz M.Current concepts in pediatric femur fracture treatment[J].Orthopedics,2007,30(12):1015-9.
[10]Karaeminogullari O,Demirors H,Atabek M,et al.Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures:effect of fracture displacement and time to surgery[J].Adv Ther,2004,21(5):335-42.
[11]Cooper C,Atkinson EJ,Jacobsen SJ,et al.Population-based study of survival after osteoporotic fractures[J].Am J Epidemiol,1993,137(9):1001-5.
[12]Dolatowski FC,Randsborg PH,Utv?g SE,et al.Comment on the article:Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures:a 5-year follow-up of randomized controlled trial[J].Arch Orthop Trauma Surg,2017,137(9):1269-1270.
[13]Lu Q,Tang G,Zhao X,et al.Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures:a 5-year follow-up of randomized controlled trial[J].Arch Orthop Trauma Surg,2017,137(1):27-35.
[14]Keating JF,Grant A,Masson M,et al.Displaced intracapsular hip fractures in fit,older people:a randomised comparison of reduction and fixation,bipolar hemiarthroplasty and total hip arthroplasty[J].Health Technol Assess,2005,9(41):iii-iv,ix-x,1-65.
[15]Leonardsson O,Garellick G,K?rrholm J,et al.Changes in implant choice and surgical technique for hemiarthroplasty:21,346 procedures from the Swedish Hip Arthroplasty Register 2005-2009[J].Acta Orthop,2012,83(1):7.
[16]Keating JF,Grant A,Masson M,et al.Randomized comparison of reduction and fixation,bipolar hemiarthroplasty,and total hip arthroplasty.Treatment of displaced intracapsular hip fractures in healthy older patients[J].Journal of Bone and Joint Surgery-American Volume,2006,88(2):249-60.
[2]Evaniew N,Madden K,Bhandari M.Cochrane in CORR?:Arthroplasties(with and without bone cement)for proximal femoral fractures in adults[J].Clin Orthop Relat Res,2014,472(5):1367-72.
[3]Johnell O,Kanis JA.An estimate of the worldwide prevalence and disability associated with osteoporotic fractures[J].Osteoporos Int,2006,17(12):1726-33.
[4]De Laet CE,Pols HA.Fractures in the elderly:epidemiology and demography[J].Baillieres Best Pract Res Clin Endocrinol Metab,2000,14(2):171-9.
[5]Bergstr?m U,Jonsson H,Gustafson Y,et al.The hip fracture incidence curve is shifting to the right[J].Acta Orthop,2009,80(5):520-4.
[6]Hagino H,Nakamura T,Fujiwara S,et al.Sequential change in quality of life for patients with incident clinical fractures:a prospective study[J].Osteoporos Int,2009,20(5):695-702.
[7]Miyamoto RG,Kaplan KM,Levine BR,et al.Surgical management of hip fractures:an evidence-based review of the literature.I:femoral neck fractures[J].J Am Acad Orthop Surg,2008,16(10):596-607.
[8]Haentjens P,Autier P,Barette M,et al.The economic cost of hip fractures among elderly women.A one-year,prospective,observational cohort study with matched-pair analysis.Belgian Hip Fracture Study Group[J].J Bone Joint Surg Am,2001,83-A(4):493-500.
[9]Kanlic E,Cruz M.Current concepts in pediatric femur fracture treatment[J].Orthopedics,2007,30(12):1015-9.
[10]Karaeminogullari O,Demirors H,Atabek M,et al.Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures:effect of fracture displacement and time to surgery[J].Adv Ther,2004,21(5):335-42.
[11]Cooper C,Atkinson EJ,Jacobsen SJ,et al.Population-based study of survival after osteoporotic fractures[J].Am J Epidemiol,1993,137(9):1001-5.
[12]Dolatowski FC,Randsborg PH,Utv?g SE,et al.Comment on the article:Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures:a 5-year follow-up of randomized controlled trial[J].Arch Orthop Trauma Surg,2017,137(9):1269-1270.
[13]Lu Q,Tang G,Zhao X,et al.Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures:a 5-year follow-up of randomized controlled trial[J].Arch Orthop Trauma Surg,2017,137(1):27-35.
[14]Keating JF,Grant A,Masson M,et al.Displaced intracapsular hip fractures in fit,older people:a randomised comparison of reduction and fixation,bipolar hemiarthroplasty and total hip arthroplasty[J].Health Technol Assess,2005,9(41):iii-iv,ix-x,1-65.
[15]Leonardsson O,Garellick G,K?rrholm J,et al.Changes in implant choice and surgical technique for hemiarthroplasty:21,346 procedures from the Swedish Hip Arthroplasty Register 2005-2009[J].Acta Orthop,2012,83(1):7.
[16]Keating JF,Grant A,Masson M,et al.Randomized comparison of reduction and fixation,bipolar hemiarthroplasty,and total hip arthroplasty.Treatment of displaced intracapsular hip fractures in healthy older patients[J].Journal of Bone and Joint Surgery-American Volume,2006,88(2):249-60.