手术治疗老年股骨颈骨折临床观察.DOCVIP

临床医学论文-手术治疗老年股骨颈骨折临床观察 ????????????????? 作者：张与平，莫润田，祁雄峰，叶安，梁晚华 【摘要】? 目的 探讨内固定、人工股骨头置换和全髋置换在治疗老年股骨颈骨折中的价值。方法 对2005～2007年收治的127例60岁以上股骨颈骨折患者进行了随访研究，比较闭合复位内固定、人工股骨头置换和全髋置换术在手术时间、出血量、住院时间、术后1年和2年的功能评价、并发症以及二次手术率方面的差异。结果 闭合复位内固定组的手术时间、失血量、住院时间均为最低(P0.05)，但卧床时间最长，并发症和手术翻修率最高，术后2年随访功能最差；全髋置换术卧床时间短，并发症和手术翻修率低，术后髋关节功能最好，但手术创伤较大，对患者身体一般状况要求较高；人工股骨头置换的手术创伤比全髋置换稍小，但并发症发生率、手术翻修率较高，术后功能比全髋置换差。结论 全髋置换治疗老年股骨颈骨折，特别是活动能力要求较高、期望寿命较长和身体一般状况好的老年患者，效果较好，值得临床推广。 【关键词】? 股骨骨折；内固定；人工髋关节；置换术；老年 ??? Abstract：? Objective? To study the effects of internal fixation(IF),femoral hemiarthroplasty(FHA) and total hip arthroplasty(THA) in treatment of femoral neck fractures in the elderly.Methods?A retrospective study was carried out in 127 elderly patients of over 60 years old of femoral neck fractures treated from June 2005 to March 2007.The differences of operating time,volume of bleeding,hospitalization time,function of joint both 1 year and 2 years post operation,complication and the rate of second operation among group IF,group FHA and group THA were compared.Results?In group IF,the operating time,volume of bleeding and hospitalization time were least,and the rate of complication and second operation was highest,while the function joint of 2 years after operation was worst.In group THA,the rate of complication and second operation was lower than that in group IF,and the function of joint was best,but the injury to the body was worse than that in group IF.In group FHA,the injury was less severe than that in group THA,while the rate of complication and second operation was higher than that in group THA,and the function of joint was worst.Conclusion?The hip arthroplasty is a reasonable treatment for femoral neck fractures in elderly,especialy those with high requirements of activity and long expected life time. ??? Key words：femoral fracture;internal fixation;artificial hip joint;displacement;elderly ?? 老年人由于骨质疏松和反应能力较差，各种外伤均可导致股骨颈骨折发生。目前，外科手术治疗主要有3种方式：闭合或开放复位内固定、半髋置换和全髋置换。对于较为年轻的患者，为保全股骨头以最大限度恢