毕晓扬;李晓辉;于建华;

• 1:天津医院关节中心
• 2:天津医院关节中心
• 3:天津医院关节中心 天津市河西区解放南路406号
• 4:300211

摘要(Abstract)：

[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(KeyWords)： 股骨颈骨折;人工关节置换术;内固定术;高龄患者

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 毕晓扬;李晓辉;于建华;

Email:

DOI:

参考文献(References)：

• [1]Sipila J,Hyvonen P,Partanen J,et al.Early revision after hemiarthro-plasty and osteosynthesis of cervical hip fracture:short-term function mortality unchanged in102patients[J].Acta Orthop Scand,2004,4:402-407.
• [2]Bhandari M,Devereaux PJ,Tornetta P3rd,et al.Operative manage-ment of displaced femoral neck fractures in elderly patients.An inter-national survey[J].J Bone Joint Surg(Am),2005,9:2122-2130.
• [3]Rogmark C,Johnell O.Primary arthroplasty is better than internal fix-ation of displaced femoral neck fractures:a meta-analysis of14ran-domized studies with2,289patients[J].Acta Orthop,2006,3:359-367.
• [4]张京新,马仲峰.老年移位型股骨颈骨折手术后疗效及生活质量的比较[J].中国矫形外科杂志,2006,16:1210-1217.
• [5]Wazir NN,Mukundala VV,Choon DS.Early results of prosthetic hip replacement for femoral neck fracture in active elderly patients[J].J Orthop Surg(Hong Kong),2006,1:43-46.
• [6]Blomfeldt R,Tornkvist H,Ponzer S,et al.Displaced femoral neck fracture:comparison of primary total hip replacement with secondary replacement after failed internal fixation:a2-year follow-up of84pa-tients[J].Acta Orthop,2006,4:638-643.
• [7]Blomfeldt R,Tornkvist H,Ponzer S,et al.Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment[J].J Bone Joint Surg(Br),2005,4:523-529.
• [8]Bjorgul K,Reikeras O.Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures:a prospective study of683patients treated with hemiarthroplasty or in-ternal fixation[J].Acta Orthop,2006,3:368-374.
• [9]毛宾尧.人工髋关节外科学[M].北京:人民卫生出版社,2002,187.
• [10]Blomfeldt R,Tornkvist H,Ponzer S,et al.Comparison of internal fixa-tion with total hip replacement for displaced femoral neck fractures.Randomized,controlled trial performed at four years[J].J Bone Joint Surg(Am),2005,8:1680-1688.
• [11]Roden M,Schon M,Fredin H.Treatment of displaced femoral neck fractures:a randomized minimum5-year follow-up study of screws and bipolar hemiprostheses in100patients[J].Acta Orthop Scand,2003,1:42-44.