双动全髋关节置换与半髋关节置换治疗老年股骨颈骨折的近期疗效比较

Comparison on short-term efficacy of total hip arthroplasty with dual-mobility cup and hemiarthroplasty in treatment of femoral neck fracture in the elderly

摘要:

目的 比较双动全髋关节置换与半髋关节置换治疗老年股骨颈骨折的近期临床疗效。方法 回顾性分析2016年6月至2019年6月航天中心医院骨科收治的老年股骨颈骨折患者47例,根据手术方式分为双动全髋关节置换组19例(观察组)和半髋关节置换组28例(对照组),记录2组患者的手术时间、失血量及住院周期,从Harris髋关节评分(HHS)、并发症及术后1年内死亡率等方面进行评估。采用SPSS 21.0软件进行数据分析。2组间计量资料比较采用t检验。结果 全部患者均获得随访,随访时间9～40个月(平均23个月)。对照组在手术时间、失血量方面优于观察组(P＜0.05),2组患者住院周期比较差异无统计学意义(P＞0.05)。2组患者术后HHS均较术前提高,且观察组在术后各随访节点HHS均优于对照组(P＜0.05),至末次随访时观察组髋关节功能恢复优良率明显占优。术后并发症发生率观察组5.3%(1/19),对照组17.9%(5/28)；术后1年内死亡率观察组5.3%(1/19),对照组7.1%(2/28),2组间比较差异无统计学意义(P＞0.05)。结论 半髋关节置换具有手术时间短、失血量少、操作简单等优点,但在术后髋部疼痛、脱位及再手术率方面较高于双动全髋关节置换,后者还可提供更好的关节功能和假体稳定性,推荐成为老年股骨颈骨折的首选手术方式。

Abstract:

Objective To compare the short-term clinical effects of total hip arthroplasty with dual-mobility cup and hemiarthroplasty for the elderly femoral neck fracture. Methods Forty-seven elderly patients with femoral neck fracture admitted in our department from June 2016 to June 2019 were enrolled in this study. According to the surgical treatments, they were divided into observation group (total hip arthroplasty with dual-mobility cup, n=19) and control group (hemiarthroplasty, n=28). The operation time, blood loss volume, and length of hospital stay, Harris hip score (HHS), incidence of complications, and postoperative mortality within 1 year were recorded and evaluated, and compared between the two groups. Results All patients were followed up for 9 to 40 months (mean 23 months). The operation time and blood loss were better in the control group than the observation group, but no significant difference was seen in length of hospital stay between the two groups (P<0.05). The postoperative HHS scores were improved in both groups after operation. The observation group had better HHS scores than the control group at the subsequent follow-up time points, and obtained predominantly better excellent rates of hip function recovery till the last follow-up. The incidence of postoperative complications was 5.3%(1/19) in the observation group and 17.9%(5/28) in the control group, and the mortality within 1 year was 5.3%(1/19) in the former and 7.1%(2/28) in the latter group, with significant difference between them (P>0.05). Conclusion Hemi-arthroplasty has the advantages of short operation time, less blood loss and simple operation, but the rates of postoperative hip pain, dislocation and reoperation are higher than those of dual-mobility total hip arthroplasty, which can also provide better joint function and prosthesis stability. So we recommend the latter operation to be the first choice for femoral neck fracture in the elderly.