股骨头双极假体置换与空心钉内固定治疗80岁以上高龄股骨颈骨折的疗效比较.DOCVIP

临床医学论文-股骨头双极假体置换与空心钉内固定治疗80岁以上高龄股骨颈骨折的疗效比较 ?????????? 作者：毕晓扬，李晓辉，于建华 【摘要】? ［目的］比较股骨头双极假体置换和螺钉内固定术治疗80岁以上高龄股骨颈骨折临床疗效。［方法］2000年1月～2005年12月本中心手术治疗80岁以上高龄有移位股骨颈骨折53例，男18例，女35例，股骨头双极假体置换36例，螺钉内固定术17例。平均随访26.72个月(12～60个月)，并进行Harris髋关节功能评价。［结果］患者平均83.69岁，螺钉内固定组手中出血少，手术时间短。股骨头双极假体置换组3例发生关节脱位，均通过闭合复位成功。随访期间，螺钉内固定组有9例8～12个月X线显示骨折愈合，3例发生骨折不愈合，再移位及螺钉松动，5例发生股骨头坏死(坏死率29.4%)，6例因不同原因行2次关节置换。平均Harris评分股骨头双极假体置换组为87.11 ± 7.34，螺钉内固定组为79.71±19.93。组间差别有显著性(P＜0.05)。［结论］股骨头双极假体置换术是治疗80岁以上高龄股骨颈骨折的有效方法，但应注意病例的选择及并存症的处理和并发症的防治。 【关键词】? 股骨颈骨折； 人工关节置换术； 内固定术； 高龄患者 ??? Abstract：［Objective］To compare the clinical and functional outcomes of bipolar femoral head arthroplasty(BFHA) and hollowpin internal fixation(HPIF) for treatment of elderly patients over 80 years with displaced femoral neck fractures (Garden types 3～4).［Method］Records of 53 patients over 80 years(35 female,18 male)with type3 or -4 femoral neck fracture (Garden classification) who underwent BFHA(36 patients),and HPIF(17 patients)at our department during January 2000 to December 2005 were reviewed.Clinical (Harris functional hip score)assessments were measured and evaluated with a mean followup period of 26.72 months(ranged,12-60 months).［Result］The mean age of the 53 patients was 83.69 years (ranged,80-92 years).The duration of operation was shorter and the blood loss was less in the group with HPIF.Dislocation of the prosthesis groups occurred postoperatively in 3 patients were reduced by closed reduction.During the followup time,9 cases treated with HPIF were shown fracture healing observed in Xray film 8-12 month after operation,3 cases shown fracture nonunion,displaced and screw loosening,5 cases shown femoral head necrosis(the necrosis rate was 29.4%),and 6 of 17 patients had been reoperated with BFHA in the? HPIF group but no patient in the bipolar femoral head arthroplasty groups.The mean Harris hip score of the BFHA group was 87.11±7.34,and the HPIF group was 79.71±19.93(P0.05).No sign of aseptic loosening or chang