老年移位型股骨颈骨折行髋关节置换术与内固定失效后再行髋关节置换术的疗效对比

目的 比较老年移位型股骨颈骨折Ⅰ期行人工全髋关节置换（THR）与内固定失效后再行THR的疗效,探讨老年移位型股骨颈骨折的治疗方法.方法 选择2006年1月至2012年12月因内固定失效后行THR的老年移位型股骨颈骨折患者22例作为观察组,另选择同期因移位型股骨颈骨折Ⅰ期行THR的老年移位型股骨颈骨折患者30例作为对照组,观察比较两组手术时间、术中出血量、Harris评分及KPS生活质量评分.结果 两组患者均成功获得随访,两组各有1例患者死亡,两组患者均未发生关节感染、翻修等严重并发症.观察组手术时间（114.82±32.13） min,明显长于对照组的（90.63±16.24） min,术中出血量（551.73±241.62） ml,明显多于对照组的（314.46±156.72） ml,差异均有统计学意义（P＜0.05）;两组术后Harris评分、KPS生活质量评分比较差异无统计学意义（P＞ 0.05）.结论 老年移位型股骨颈骨折Ⅰ期行THR手术风险低于内固定失效后再行THR,但在术后髋关节功能恢复及提高患者生活质量方面两种方法相似.

Comparison of the effect between the hip replacement and the hip replacement after failed internal fixation in elderly patients with displaced femoral neck fracture

Objective To compare the clinical effect of the primary total hip replacement （THR） and the secondary THR after failed internal fixation in elderly patients with displaced femoral neck fracture, so as to investigate the optimal treatment for displaced femoral neck fractures in elderly patients. Methods From January 2006 to December 2012,22 patients treated with a secondary THR after failed internal fixation were chosen as the observation group and 30 patients treated with a primary THR were chosen as the control group, the operation time, blood loss, postoperative Harris scores for hip joint and health-related quality of life （ KPS index score ） were observed and analyzed in two groups. Results Both of the groups were followed up successfully and each of the groups had 1 patient died. There were no joint infection, re-operations and any other complications in both groups. The operation time in observation group was longer than that in control group （114.82 ±32.13） min vs. （90.63 ±16.24） mini,blood loss was more than that in control group （551.73 ±241.62） ml vs. （314.46 ± 156.72） ml] ,there was significant difference （P 〈 0.05）. But the Harris score and KPS index score between two groups had no significant differences （P 〉 0.05 ）. Conclusion The primary THR in elderly patients with displaced femoral neck fracture has lower risk in operation to compare with the secondary THR after failed internal fixation, but the two ways are similar in the hip joint function recovery and improve patients quality of life.