半髋置换与内固定修复老年股骨颈骨折后的生活质量对比

发布时间：2018-06-07 00:42

  本文选题：股骨骨折 + 内固定器　； 参考：《中国组织工程研究》2017年19期

【摘要】：背景:股骨颈骨折仍然被认为是一种尚未解决的疾病,主要原因在于是采取内固定还是采用牺牲解剖结构的关节置换手术一直存在争议。这种争议来源于采用内固定治疗可能出现骨不连和股骨头缺血坏死,从而带来远期功能恢复的不满意。是否能通过骨折良好复位,确切固定以及积极功能锻炼改善预期呢?如果可能,那将有益于老年股骨颈骨折,特别是本身合并严重基础疾病的患者恢复。目的:比较植入物内固定与半髋置换修复老年新鲜股骨颈骨折患者生活质量的差异。方法:回顾性分析2010年1月至2013年12月大连医科大学附属第一医院收治的148例大于60岁的股骨颈骨折患者,比较内固定和半髋置换分别在无移位型(GardenⅠ、GardenⅡ型)及移位型(GardenⅢ、GardenⅣ型)股骨颈骨折患者手术时间、出血量、住院时间、死亡率、再手术率及术后生活质量的差异,术后生活质量采用Harris评分及SF-36量表评估。结果与结论:(1)148例患者中137例获得随访,随访率92.6%;(2)手术时间、术中出血量和住院时间比较,不论是无移位型,还是移位型股骨颈骨折,均为内固定组明显优于半髋置换组(P0.05);(3)两种修复方式死亡率差异无显著性意义,再手术率内固定组略高于半髋置换组;(4)两种修复方式术后的Harris评分及SF-36评分均随着时间的延长而升高,2组间的差距随着时间的延长而不断接近,于术后2.5年即可达到相等(P0.05),且内固定术修复无移位型股骨颈骨折比移位型可更早获得与半髋置换相同的生活质量;(5)结果表明,植入物内固定在修复老年股骨颈骨折上,具有手术时间短、操作简单、创伤小等明显的优势,并且保留了自身股骨头,在术后2.5年即可达到与半髋关节置换相同的生活质量;尤其是随着科技的发展和手术技术的成熟,当代内固定术完全可以满足患者术后早期下地的需求,使其优势更加突出。因此,植入物内固定是修复老年股骨颈骨折的有效方法。
[Abstract]:Background: femoral neck fractures are still considered to be an unsolved disease, mainly due to the controversy over whether to use internal fixation or arthroplasty with sacrificial anatomical structures. This controversy stems from the possibility of nonunion and avascular necrosis of the femoral head after internal fixation, which results in unsatisfactory long-term functional recovery. Is it possible to improve expectations through good fracture reduction, precise fixation, and active functional exercise? If possible, it will benefit elderly patients with femoral neck fractures, especially if they are associated with severe underlying diseases. Objective: to compare the quality of life (QOL) between implants and hemihip arthroplasty in the repair of fresh femoral neck fractures. Methods: from January 2010 to December 2013, 148 patients with femoral neck fractures aged more than 60 years were treated in the first affiliated Hospital of Dalian Medical University. The operative time, bleeding volume, hospital stay, mortality, reoperation rate and quality of life of the patients with femoral neck fracture were compared between internal fixation and half hip replacement in Garden 鈪，

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