三种术式治疗老年移位型股骨颈骨折的近期疗效分析

发布时间：2018-06-27 09:24

本文选题：内固定术 + 全髋关节置换术　；参考：《苏州大学》2015年硕士论文

【摘要】：目的比较多枚加压螺钉内固定术、全髋关节置换术和人工股骨头置换术治疗老年移位型股骨颈骨折的近期疗效。方法通过回顾性分析我院自2008年2月至2013年10月间收治并且获得完整随访的70例老年股骨颈骨折患者,按照手术方式不同分为三组,A组为多枚加压螺钉内固定组(n=20),B组为全髋关节置换术组(n=27),C组为人工股骨头置换术组(n=23)。比较三种手术方式的手术时间、术中出血量、术后卧床时间、医疗费用,术后并发症的发生率、以及随访1-3年以后髋关节功能评分。结果A组在手术时间、术中出血量要少于B、C组(P0.05)。而A组在术后下地负重时间明显晚于B、C两组(P0.05),且术后并发症的发生率高于B、C两组(P0.05)。三组医疗费用均有差异,B组最高,C组次之,A组最少,差异有统计学意义(P0.05)。术后1-3年Harris评分的优良率B、C两组高于A组,与A组差异存在统计学意义(P0.05),术后1-2年B、C两组之间差异没有统计学意义(P0.05),而术后3年Harris评分的优良率B组高于C组,差异存在统计学意义(P0.05)。结论对于老年移位型股骨颈骨折,临床上更倾向选择关节置换术。如果患者的年龄、预期寿命、身体情况以及经济条件允许,建议行全髋置换术。
[Abstract]:Objective to compare the short term effects of multiple compression screws internal fixation total hip arthroplasty and artificial femoral head replacement in the treatment of displaced femoral neck fractures in the elderly. Methods 70 elderly patients with femoral neck fracture who were admitted to our hospital from February 2008 to October 2013 were retrospectively analyzed. According to the different operation methods, three groups were divided into three groups: group A: multiple internal fixation with compression screws (n = 20) and group B: total hip arthroplasty (n = 27) and group C: artificial femoral head replacement (n = 23). The operative time, blood loss, bed-rest time, medical expenses, incidence of postoperative complications and hip joint function score were compared among the three types of operation. Results the blood loss during operation in group A was less than that in group B (P 0.05). The weight loading time in group A was significantly later than that in group B (P 0.05), and the incidence of postoperative complications was higher than that in group B (P 0.05). There were differences in medical expenses among the three groups. Group B had the highest medical expenses and group C had the lowest. The difference was statistically significant (P0.05). The excellent and good rate of Harris score in group B was higher than that in group A in 1-3 years postoperatively (P0.05), but there was no significant difference between group B and group A in 1-2 years after operation (P0.05), but the excellent and good rate of group B was higher than that of group C 3 years after operation. The difference was statistically significant (P0.05). Conclusion in elderly patients with displaced femoral neck fractures, arthroplasty is more preferred. Total hip replacement is recommended if the patient's age, life expectancy, physical condition and financial conditions permit.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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