【摘要】：目的:今天的中國(guó)老齡化社會(huì)已經(jīng)到來,老年人由于外傷導(dǎo)致的股骨頸骨折發(fā)病率也在日益增多,由于老年人普遍存在的骨質(zhì)疏松、基礎(chǔ)內(nèi)科疾病等因素,越來越多的學(xué)者開始關(guān)注高齡老人股骨頸骨折特殊性,此類骨折早已不再只有單純切開復(fù)位內(nèi)固定術(shù)一種選擇,越來越多人開始使用人工關(guān)節(jié)置換。雖然應(yīng)用生物雙極股骨頭置換術(shù)治療新鮮的高齡骨折患者早已經(jīng)成為臨床醫(yī)生們的選擇之一,但是目前主流的觀點(diǎn)依然認(rèn)為生物全髖關(guān)節(jié)置換術(shù)是治療這一類患者的首選方案。生物全髖關(guān)節(jié)置換術(shù)對(duì)患者身體素質(zhì)的要求較高,創(chuàng)傷較大,而且在我們臨床觀察中,接受生物全髖關(guān)節(jié)置換的患者預(yù)后效果并未體現(xiàn)出明顯的優(yōu)勢(shì)。在本項(xiàng)研究中,我們回顧了接受生物雙極股骨頭置換術(shù)的高齡新鮮股骨頸骨折患者的臨床資料,對(duì)比了此類手術(shù)方式和全髖關(guān)節(jié)置換術(shù)兩組病人的手術(shù)相關(guān)情況,以及術(shù)后的療效隨訪,探討將生物雙極股骨頭置換術(shù)作為治療不穩(wěn)定型高齡股骨頸骨折的首選手術(shù)方案的可行性和優(yōu)勢(shì)。方法:本次研究以我院2007年1月-2015年3月收治高齡新鮮GardenⅢ、Ⅳ型股骨頸骨折患者共130例作為研究對(duì)象,分為生物雙極半髖置換組(62例)和生物全髖置換組(68例),分別采用生物雙極股骨頭置換術(shù)和生物全髖關(guān)節(jié)置換術(shù)兩種方式治療;比較兩組患者的手術(shù)時(shí)間、術(shù)中出血量、總失血量及住院時(shí)間在內(nèi)圍手術(shù)期臨床指標(biāo)值;記錄患者術(shù)后隨訪并發(fā)癥發(fā)生例數(shù),包括肺炎、下肢血栓、尿路感染、髖部疼痛、松動(dòng)及髖臼磨損等,計(jì)算發(fā)生率。隨訪術(shù)后1年、3年和5年兩組患者的Harris評(píng)分,計(jì)算兩組的差異。結(jié)果:生物雙極半髖置換組患者手術(shù)時(shí)間、術(shù)中出血量及總出血量均顯著優(yōu)于生物全髖置換組,差異具有顯著性意義(p0.05);兩組患者住院時(shí)間比較差異無顯著性意義(p0.05);兩組患者隨訪1年、3年及5年的Harris髖關(guān)節(jié)功能評(píng)分優(yōu)良率比較差異無顯著性意義(p0.05);兩組患者術(shù)后并發(fā)癥發(fā)生率無明顯差異(p0.05)。結(jié)論:2種術(shù)式均可有效治療不穩(wěn)定型老年股骨頸骨折,近期及中期隨訪結(jié)果滿意。生物型雙動(dòng)股骨頭置換術(shù)有助于縮短手術(shù)操作時(shí)間和減少術(shù)中創(chuàng)傷,適應(yīng)性更廣,近中期治療效果與全髖關(guān)節(jié)置換相當(dāng),術(shù)后并發(fā)癥無明顯增加。生物型雙動(dòng)股骨頭置換可以作為治療不穩(wěn)定型老年股骨頸骨折的首選手術(shù)方式之一。
[Abstract]:Objective: today's aging society in China has arrived, the incidence of femoral neck fractures caused by trauma is also increasing in the elderly, because of the prevalence of osteoporosis, basic medical diseases and other factors in the elderly. More and more scholars begin to pay attention to the particularity of femoral neck fracture in the elderly. This kind of fracture is no longer only an option of open reduction and internal fixation, but more and more people begin to use artificial joint replacement. Although biological bipolar femoral head replacement has long been a choice of clinicians for the treatment of fresh elderly fracture, the current mainstream view is that biological total hip replacement is the first choice for the treatment of this kind of patients. Biological total hip arthroplasty requires higher physical quality and greater trauma, and in our clinical observation, the prognosis of patients receiving biological total hip replacement does not show obvious advantages. In this study, we reviewed the clinical data of elderly patients with fresh femoral neck fractures undergoing bipolar femoral head replacement, and compared the surgical outcomes between the two groups of patients undergoing total hip arthroplasty. To explore the feasibility and advantage of bipolar femoral head replacement as the first choice for unstable femoral neck fracture. Methods: from January 2007 to March 2015, 130 elderly patients with fresh Garden 鈪，

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