两种手术方式治疗有移位的头下型股骨颈骨折的临床疗效对比
发布时间：2018-11-14 10:09
【摘要】：目的:通过回顾性研究,比较人工全髋关节置换术与闭合复位空心加压螺钉内固定术对年龄在55-65岁之间有移位的头下型股骨颈骨折的患者的临床疗效。方法:选取大连医科大学附属第一医院2009年9月-2015年12月收治的55-65岁年龄段有移位的头下型股骨颈骨折患者162例,符合入组条件且拥有完整随访资料的共71例,进行回顾性研究。随访数据均来源于本科室已掌握资料。根据手术方式的不同来分为人工全髋关节置换组(THA组)和内固定组(IF组)。THA换组39例,其中男性10例,女性29例;年龄55-65岁之间,平均年龄(59.79±3.17)岁;骨折按解剖分型均为头下型,按Garden分型:Ⅲ型14例,Ⅳ型25例。IF组32例,其中男性12例,女性20例;年龄55-65岁,平均年龄(58.38±2.84)岁;同样骨折按解剖分型均为头下型,骨折按Garden分型:Ⅲ型18例,Ⅳ型14例。所有病例均获得随访,随访时间12-30个月,平均15.14个月。两组分别行人工全髋关节(生物型)置换术和闭合复位空心加压螺钉内固定术。通过查阅本科室已有数据库中患者基本资料,回访数据,收集患者术前合并症情况、手术时间、术中出血量、部分负重时间、住院时间的情况,记录患者术后并发症发生情况,对患者术后3个月、6个月、12个月的髋关节功能进行记录,临床疗效评价采用Harris评分系统。将收集、整理好的所有数据输入统计软件,运用相应的统计学方法进行数据分析。结果:所选取患者术后均获得随访,通过分析所得数据:THA组在手术时间显著长于IF组(P0.05),术中出血量显著大于IF组(P0.05);而THA组术后开始下床活动、患肢部分负重时间显著短于IF组(P0.05)。两组在住院时间的比较上无明显统计学差异(P0.05)。THA组的早期并发症发病率为7.7%,低于IF组15.6%,两者之间无明显统计学差异(P0.05);远期并发症发病率为0.0%,远低于IF组12.5%(P0.05)。而IF组发生骨不连以及股骨头坏死的4名患者均需要再行手术,而THA组则没有1例需再行手术者,两者再手术率存在明显统计学差异(P0.05)。在末次随访时,从评分等级来看,髋关节的Harris评分THA组显著优于IF组(P0.05),而从优良率的角度来看,THA组的优良率为94.9%,显著高于IF组患者75.0%(P0.05)。THA组与IF组相比,术后3个月,6个月以及12个月,THA组的Harris评分均显著高于IF组(P均0.05)。结论:1、人工全髋关节置换术对患者的身体一般情况要求较高,但其优点在于患者早期即可进行肢体部分负重和相应功能锻炼,能给患者带来更好的术后髋关节功能恢复。2、闭合复位空心加压螺钉内固定术相对简单、手术时间短、创伤小,但患肢长时间不能进行负重及相应功能锻炼是其巨大缺陷。3、对于有移位的头下型股骨颈骨折,55-65岁这一年龄段的患者,建议患者首先考虑选择人工全髋关节置换术。
[Abstract]:Objective: to compare the clinical effects of total hip arthroplasty and closed reduction and hollow screw fixation in patients with subcephalic femoral neck fractures between 55 and 65 years old. Methods: 162 patients with displaced subcephalic femoral neck fractures between September 2009 and December 2015 in the first affiliated Hospital of Dalian Medical University were selected. A retrospective study was carried out. The follow-up data were all obtained from the department. According to the different operation methods, the patients were divided into artificial total hip replacement group (THA group) and internal fixation group (IF group,). THA replacement group, 39 cases, male 10 cases, female 29 cases, mean age (59.79 卤3.17) years old, 55-65 years old), and total hip replacement group (THA group) and internal fixation group (IF group). The fractures were classified as subcephalic type according to anatomic classification, and according to Garden classification: type 鈪，
本文编号：2330865
[Abstract]:Objective: to compare the clinical effects of total hip arthroplasty and closed reduction and hollow screw fixation in patients with subcephalic femoral neck fractures between 55 and 65 years old. Methods: 162 patients with displaced subcephalic femoral neck fractures between September 2009 and December 2015 in the first affiliated Hospital of Dalian Medical University were selected. A retrospective study was carried out. The follow-up data were all obtained from the department. According to the different operation methods, the patients were divided into artificial total hip replacement group (THA group) and internal fixation group (IF group,). THA replacement group, 39 cases, male 10 cases, female 29 cases, mean age (59.79 卤3.17) years old, 55-65 years old), and total hip replacement group (THA group) and internal fixation group (IF group). The fractures were classified as subcephalic type according to anatomic classification, and according to Garden classification: type 鈪，
本文编号：2330865
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