不同类型髋关节置换治疗高龄股骨颈骨折的比较研究
发布时间：2018-10-31 20:34
【摘要】：目的:今天的中国老龄化社会已经到来,老年人由于外伤导致的股骨颈骨折发病率也在日益增多,由于老年人普遍存在的骨质疏松、基础内科疾病等因素,越来越多的学者开始关注高龄老人股骨颈骨折特殊性,此类骨折早已不再只有单纯切开复位内固定术一种选择,越来越多人开始使用人工关节置换。虽然应用生物双极股骨头置换术治疗新鲜的高龄骨折患者早已经成为临床医生们的选择之一,但是目前主流的观点依然认为生物全髋关节置换术是治疗这一类患者的首选方案。生物全髋关节置换术对患者身体素质的要求较高,创伤较大,而且在我们临床观察中,接受生物全髋关节置换的患者预后效果并未体现出明显的优势。在本项研究中,我们回顾了接受生物双极股骨头置换术的高龄新鲜股骨颈骨折患者的临床资料,对比了此类手术方式和全髋关节置换术两组病人的手术相关情况,以及术后的疗效随访,探讨将生物双极股骨头置换术作为治疗不稳定型高龄股骨颈骨折的首选手术方案的可行性和优势。方法:本次研究以我院2007年1月-2015年3月收治高龄新鲜GardenⅢ、Ⅳ型股骨颈骨折患者共130例作为研究对象,分为生物双极半髋置换组(62例)和生物全髋置换组(68例),分别采用生物双极股骨头置换术和生物全髋关节置换术两种方式治疗;比较两组患者的手术时间、术中出血量、总失血量及住院时间在内围手术期临床指标值;记录患者术后随访并发症发生例数,包括肺炎、下肢血栓、尿路感染、髋部疼痛、松动及髋臼磨损等,计算发生率。随访术后1年、3年和5年两组患者的Harris评分,计算两组的差异。结果:生物双极半髋置换组患者手术时间、术中出血量及总出血量均显著优于生物全髋置换组,差异具有显著性意义(p0.05);两组患者住院时间比较差异无显著性意义(p0.05);两组患者随访1年、3年及5年的Harris髋关节功能评分优良率比较差异无显著性意义(p0.05);两组患者术后并发症发生率无明显差异(p0.05)。结论:2种术式均可有效治疗不稳定型老年股骨颈骨折,近期及中期随访结果满意。生物型双动股骨头置换术有助于缩短手术操作时间和减少术中创伤,适应性更广,近中期治疗效果与全髋关节置换相当,术后并发症无明显增加。生物型双动股骨头置换可以作为治疗不稳定型老年股骨颈骨折的首选手术方式之一。
[Abstract]:Objective: today's aging society in China has arrived, the incidence of femoral neck fractures caused by trauma is also increasing in the elderly, because of the prevalence of osteoporosis, basic medical diseases and other factors in the elderly. More and more scholars begin to pay attention to the particularity of femoral neck fracture in the elderly. This kind of fracture is no longer only an option of open reduction and internal fixation, but more and more people begin to use artificial joint replacement. Although biological bipolar femoral head replacement has long been a choice of clinicians for the treatment of fresh elderly fracture, the current mainstream view is that biological total hip replacement is the first choice for the treatment of this kind of patients. Biological total hip arthroplasty requires higher physical quality and greater trauma, and in our clinical observation, the prognosis of patients receiving biological total hip replacement does not show obvious advantages. In this study, we reviewed the clinical data of elderly patients with fresh femoral neck fractures undergoing bipolar femoral head replacement, and compared the surgical outcomes between the two groups of patients undergoing total hip arthroplasty. To explore the feasibility and advantage of bipolar femoral head replacement as the first choice for unstable femoral neck fracture. Methods: from January 2007 to March 2015, 130 elderly patients with fresh Garden 鈪，
本文编号：2303456
[Abstract]:Objective: today's aging society in China has arrived, the incidence of femoral neck fractures caused by trauma is also increasing in the elderly, because of the prevalence of osteoporosis, basic medical diseases and other factors in the elderly. More and more scholars begin to pay attention to the particularity of femoral neck fracture in the elderly. This kind of fracture is no longer only an option of open reduction and internal fixation, but more and more people begin to use artificial joint replacement. Although biological bipolar femoral head replacement has long been a choice of clinicians for the treatment of fresh elderly fracture, the current mainstream view is that biological total hip replacement is the first choice for the treatment of this kind of patients. Biological total hip arthroplasty requires higher physical quality and greater trauma, and in our clinical observation, the prognosis of patients receiving biological total hip replacement does not show obvious advantages. In this study, we reviewed the clinical data of elderly patients with fresh femoral neck fractures undergoing bipolar femoral head replacement, and compared the surgical outcomes between the two groups of patients undergoing total hip arthroplasty. To explore the feasibility and advantage of bipolar femoral head replacement as the first choice for unstable femoral neck fracture. Methods: from January 2007 to March 2015, 130 elderly patients with fresh Garden 鈪，
本文编号：2303456
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