标题：老年移位性股骨颈骨折手术方案的选择

      作者：蔡 程，齐保闯，徐显春，邓学海
    （宜宾市第一人民医院骨科，四川 宜宾 644000）

      卷次： 2015年26卷2期

      【摘要】 目的 比较老年人移位股骨颈骨折Ⅰ期行人工全髋关节置换（Total hip replacement，THR）与内固定
失效后再行THR疗效，探讨老年人移位股骨颈骨折的治疗方法。方法 将2006年1月至2012年12月因内固定失效
后行THR 22例老年移位股骨颈骨折纳入观察组，同期因移位股骨颈骨折Ⅰ期行THR的老年患者30例纳入对照组，
观察并比较两组患者的手术时间、术中出血量、Harris评分及卡氏生活质量评分。结果 所有患者均成功随访，两组
各有1例患者死亡，两组患者均未发生关节感染、翻修等严重并发症。观察组THR手术时间[(114.82±32.13) min]高
于对照组[(90.63±16.24) min]，其差异有统计学意义(P<0.05)；观察组THR术中出血量[(551.73±241.62) ml]高于对照
组[(314.46±156.72) ml]，其差异具有显著的统计学意义(P<0.05)；观察组术后随访时的Harris评分[(88.24±6.71)分]与
对照组[(91.52±6.24)分]比较差异无统计学意义(P>0.05)；观察组术后随访时的卡氏生活质量评分[(94.62±0.85)分]与
对照组[(96.03±0.76)分]比较差异无统计学意义(P>0.05)。结论 Ⅰ期行THR手术治疗老年人移位股骨颈骨折风险
低于内固定失效后再行THR，是临床治疗老年移位性股骨颈骨折较优的治疗选择。

      【关键词】 股骨颈骨折；老年人；人工全髋关节置换术；内固定术

      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2015）02—0251—03


Choice of operative schemes in elderly patients with displaced femoral neck fracture.
CAI Cheng, QI
Bao-chuang, XU Xian-chun, DENG Xue-hai. Department of Orthopedics, the First People's Hospital of Yibin, Yibin
644000, Sichuan, CHINA

【Abstract】 Objective To compare the clinical effects of primary total hip replacement (THR) and secondary
THR after failed internal fixation in the elderly patients with displaced femoral neck fracture so as to investigate the
optimal treatment for displaced femoral neck fractures in the elderly patients. Methods Twenty-two patients treated
with secondary THR after failed internal fixation between January 2006 and December 2012 were in observation
group and 30 cases treated with primary THR were in control group. The data of each group were recorded separately,
and operation time, blood loss, postoperative Harris scores for hip joint and health-related quality of life (KPS score)
were observed and analyzed. Results Both of the groups were followed up successfully. Each group has one patient
died, and there were no joint infection, re-operations or any other complications in both of the groups. Operative duration
of observation group [(114.82±32.13) min] was longer than operative duration in control group [(90.63±16.24) min].
There was statistically significant difference (P<0.05). Blood loss of observation group [(551.73±241.62) ml] was more
than that in control group [(314.46±156.72) ml]. There was statistically significant difference (P<0.05). At follow up,
there was no statistically significant difference in Harris score between observation group (88.24 ± 6.71) and control
group (91.52±6.24), (P>0.05). There was also no statistically significant difference in KPS score between observation
group (94.62±0.85) and control group (96.03±0.76), P>0.05. Conclusion The primary THR for displaced femoral
neck fracture in elderly patient showed lower risk in the operation compared with the secondary THR after failed inter-
nal fixation. THR is an optimal treatment for displaced femoral neck fractures in the elderly patients.

      【Key words】 Femoral neck fractures; Elderly; Artificial total hip arthroplasty; Internal fixation