白哲

[摘要] 目的 对比分析髋关节置换术与骨折内固定术治疗老年股骨颈骨折的临床效果。 方法 回顾性分析2019年3月至2020年3月期间我院收治的老年股骨颈骨折患者共105例，按照治疗方法分为两组，对照组52例用骨折内固定术治疗，研究组53例用髋关节置换术治疗，对比分析两组治疗效果、Harris评分、关节功能恢复情况。 结果 与对照组比较，研究组骨折愈合时间、下床时间、住院时间[（12.9±2.2）周vs. （17.1±3.6）周、（14.3±1.8）d vs.（28.8±5.7）d、（12.0±2.1）d vs. （17.4±4.0）d]均更短，两组差异有统计学意义（P<0.05）。治疗后两组Harris评分均高于治疗前，差异有统计学意义（P<0.05）;治疗后研究组Harris评分高于对照组[（80.2±13.6）分 vs. （71.9±10.3）分]，差异有统计学意义（P<0.05）。与对照组比较，研究组关节功能优良率（92.4% vs. 71.1%）更高，两组差异有统计学意义（P<0.05）。结论 髋关节置换术与骨折内固定术治疗老年股骨颈骨折患者均能收到良好的治疗效果，但髋关节置换术治疗能够更好地缩短患者骨折愈合时间、下地时间及住院时间，能够促进患者更好地恢复功能状态。

[关键词] 老年;股骨颈骨折;髋关节置换术;骨折内固定术;Harris评分;优良率

[中圖分类号] R687.3          [文献标识码] B          [文章编号] 1673-9701（2021）04-0064-04

Comparative study on the clinical effect between hip replacement and internal fracture fixation in the treatment of elderly femoral neck fractures

BAI Zhe

Pelvic and Acetabular Surgery Ward， Shenyang Orthopedic Hospital， Shenyang   110044， China

[Abstract] Objective To compare and analyze the clinical effect between hip replacement and internal fracture fixation in the treatment of elderly femoral neck fractures. Methods A total of 105 elderly patients with femoral neck fractures admitted to our hospital from March 2019 to March 2020 were retrospectively analyzed. They were divided into two groups according to treatment methods. The control group（n=52） was treated with internal fracture fixation， and the study group（n=53） was treated with hip replacement. The treatment effect， Harris score and joint function recovery of the two groups were compared and analyzed. Results Compared with those of the control group， the fracture healing time， the time of going to the ground， and the hospitalization time in the study group were shorter （[12.9±2.2] weeks vs. [17.1±3.6] weeks， [14.3±1.8]d vs. [28.8±5.7] d， [12.0±2.1] d vs. [17.4±4.0] d）， and the difference between the two groups was statistically significant（P<0.05）. After treatment， the Harris scores of the two groups were higher than those before treatment， and the difference was statistically significant（P<0.05）. The Harris score of the study group was higher than that of the control group （[80.2±13.6]points vs. [71.9±10.3]points）， and the difference was statistically significant（P<0.05）. Compared with that of the control group， the excellent and good rate of joint function in the study group was higher（92.4% vs. 71.1%）， and the difference between the two groups was statistically significant（P<0.05）. Conclusion Both hip replacement and internal fracture fixation can achieve good results in the treatment of elderly patients with femoral neck fractures， but hip replacement can better shorten the fracture healing time， the time of going to the ground and the length of stay， which can promote patients to better recover their functional status.

[Key words] Elderly; Femoral neck fracture; Hip replacement; Internal fracture fixation; Harris score; Excellent and good rate

股骨颈骨折是临床常见的一种骨折类型，属于全身大型骨折，在全身骨折中约占3.6%，其发生的原因多为外力导致，包括交通事故、跌伤、高处坠落等，随着我国逐渐步入老龄化社会及交通、建筑业的快速发展，股骨颈骨折的发生率呈现逐年升高的趋势。而老年股骨颈骨折患者由于年龄较大，存在慢性支气管炎、高血压、糖尿病等基础疾病较多及骨质疏松等特点，治疗难度也较大，此外，老年患者机体恢复能力差，手术后骨折愈合需要的时间较长，术后造成股骨头缺血坏死等并发症发生率相对较高[1]。临床治疗股骨颈骨折常用的手术方法包括骨折内固定术、髋关节置换术等，对股骨颈骨折采用手术治疗主要是能使患者快速有效地恢复负重运动功能，缩短卧床时间，降低并发症发生率，减少股骨头坏死等不良反应的发生风险[2]。本研究对2019年3月至2020年3月期间我院收治的105例老年股骨颈骨折患者进行分析，将患者分组后，分别用骨折内固定术及髋关节置换术进行治疗，比较不同手术方法治疗股骨颈骨折的临床疗效，现报道如下。……