髋关节置换手术与动力髋螺钉内固定治疗移位型股骨颈骨折的疗效比较

Comparison of effect of hip replacement surgery and dynamic hip screw fixation for displaced femoral neck fractures

摘要:

目的比较髋关节置换手术与动力髋螺钉内固定手术治疗移位型股骨颈骨折患者的临床疗效。方法回顾性分析2014 年1-2014 年12 月该院收治的100 例移位型股骨颈骨折患者的临床资料，采用全髋关节置换手术治疗的63例患者设为观察组，采用动力髋螺钉内固定手术治疗的37例患者设为对照组。对比两组患者围手术期情况、术后1年和2年髋关节功能改良Aubign佴-Postel评分、术后1和2年并发症发生情况、各项治疗费用。结果观察组的切口长度、术中出血量、输血量、手术时间和住院时间与对照组比较，差异有统计学意义（p < 0.05）。观察组与对照组术前、术后1 年和2 年的髋关节功能改良Aubign佴-Postel评分比较，采用重复测量设计的方差分析：①两组的疼痛，活动范围，行走能力及总分比较，差异有统计学意义（p <0.05）；②不同时间的疼痛、活动范围、行走能力及总分比较，差异无统计学意义（p >0.05）；③两组的疼痛、活动范围、行走能力及总分比较，差异有统计学意义（p <0.05）。术后1 年观察组和对照组患者的并发症总发生率分别为9.6%和18.9%，术后2 年对照组和观察组患者的并发症发生率分别为25.6%和29.7%，差异无统计学意义（p >0.05）。观察组的初次手术费用高于对照组，再次手术费用和求医问药费用低于对照组，总费用稍高于对照组。结论采用髋关节置换手术治疗移位型股骨颈骨折较动力髋螺钉内固定治疗近期并发症发生率较低，远期临床疗效较佳，髋关节功能较好，但其治疗总费用稍高，患者可以根据自身情况选择。

Abstract:

Objective To compare the clinical curative effect of hip replacement surgery and dynamic hip screw internal fixation in treatment of displaced femoral neck fractures. Methods From January to December 2014, 100 patients with displaced femoral neck fractures were treated in our hospital. Their clinical data were retrospectively analyzed. Among them 63 cases were treated with total hip replacement surgery (observation group) and 37 patients were treated with dynamic hip screw internal fixation (control group). Then perioperative situation of the patients, hip joint function improvement Aubigné-Postel score 1 and 2 y after operation, occurrence of complications in 1 and 2 y after operation, and cost of treatment were compared between the two groups. Results The incision length, blood loss, intraoperative blood transfusion, operation time and hospitalization time were statistically different between the observation group and the control group (p < 0.05). In comparison of Aubigné-Postel hip joint function improvement score before operation, 1 and 2 y after operation between the two groups, the analysis of variance of repeated measurement data was used. The results showed that pain, movement, walking ability and total score were statistically different between the two groups (p < 0.05) and also different among different time points in each group (p < 0.05). The change trends of pain, movement, walking ability and total score had statistical differences (p < 0.05). The total incidence of complications was 9.6% in the observation group and 18.9% in the control group 1 y after operation, and was 25.6% in the control group and 29.7% in the observation group 2 y after operation, the differences were not statistically significant (p > 0.05). The initial surgical cost of the observation group was significantly higher than that of the control group, the cost of re-surgery and other medical costs were significantly lower than those of the the control group, the total cost in the observation group was slightly higher than that in the control group, the differences were statistically significant (p < 0.05). Conclusions For treatment of displaced femoral neck fractures, hip replacement surgery has lower incidence of short-term complications, and better long-term clinical efficacy and hip function compared to dynamic hip screw fixation, but the cost of treatment is higher. Therefore, patients can make choice according to their own circumstances.