两种手术方案治疗老年股骨颈骨折 合并移位的疗效及费用比较

Comparison of 2 types of surgical approachin elderly patients with femoral neck fracture

摘要:

目的 探讨空心钉内固定方案和全髋关节置换方案对合并移位老年股骨颈骨折患者的疗效及费用 比较。方法 选取2013 年6 月-2015 年6 月该院收治合并移位老年股骨颈骨折的130 例患者，根据手术方案不 同将其分为A 组和B 组，每组各65 例。分别采用空心钉内固定方案和全髋关节置换方案治疗；比较两组手术 相关临床指标、术后髋关节功能恢复效果、术后Harris 评分、2 次手术率、术后并发症发生率及治疗费用等。 结果 A 组手术用时和术中失血量均优于B 组（P <0.05）；B 组术后首次锻炼时间短于A 组（P <0.05）；B 组 术后髋关节功能恢复效果优于A 组（P <0.05）；B 组术后第3、6、12、18 及24 个月Harris 评分均高于A 组 （P <0.05）；B 组2 次手术率低于A 组（P <0.05）；两组术后并发症发生率比较无差异（P >0.05）；B 组首次 手术费用高于A 组（P <0.05）；B 组2 次手术费用低于A 组（P <0.05）；两组总治疗费用比较，差异无统计学 意义（P >0.05）。结论 全髋关节置换方案用于合并移位老年股骨颈骨折患者治疗可加快术后康复进程，改善 髋关节活动功能，降低2 次手术风险，且未增加总治疗费用；而空心钉内固定方案则有助于降低手术操作难度， 减少术中医源性创伤。

Abstract:

Objective To investigate the characteristics of internal fixation with hollow screw and total hip arthroplasty on hip function recovery in elderly patients with femoral neck fracture. Methods A total of 130 elderly patients admitted in our hospital with femoral neck fracture from June 2013 to June 2015 were involved. Patients were randomly divided into group A in which patients received internal fixation with hollow screw, and group B in which patients received total hip arthroplasty. Postoperative recovery of hip function, Harris score, incidence of complications, reoperation rate, and costs of both groups were recorded. Results The operation time and intraoperative blood loss in group A were significantly decreased compared with group B (P < 0.05). The time to start first exercise, functional recoveryof hip, Harris score 3, 6, 12, 18 and 24 months after operation, incidence of re-operation in B group were significantly better than those in group A (P < 0.05). Costs for first operation were significantly higher while costs for second operation in group B were significantly lower compared with group A (P < 0.05). No significant difference in the incidence of postoperative complications and cost between 2 groups was identified (P > 0.05). Conclusion Total hip arthroplasty efficiently accelerates the functional recovery, reduces the risk of re-operation while does not increase the complications and costs in the treatment of elderly patients with femoral neck fracture. Still, internal fixation with hollow screw application is easier and decreases intraoperativeinjury.