摘要
目的:探讨复位內固定,双极半髋关节置换及全髋关节置换3种手术方法治疗股骨颈骨折的临床疗效。方法:回顾性分析研究我院187例股骨颈骨折患者的临床资料。所有患者均随机采用复位内固定、双极半髋关节置换或全髋关节置换3种不同的手术方法治疗。对比分析3种治疗方法临床疗效。功能结果的评估使用髋关节分级问卷(hip-rating questionnaire)和EuroQol健康状态测量表(EuroQol health status measure)。临床结果的评估包括死亡率和并发症。同时比较3种手术方法的治疗费用。所有病例随访2年。结果:187例患者随机采用复位內固定、双极半髋关节置换或全髋关节置换术3种手术方法之一治疗。各治疗组患者的死亡率无显著差异。复位內固定组患者的2次手术率最高(复位內固定组39%,双极半髋关节置换组5%,全髋关节置换组9%)。在随访第4个月及第12个月,复位內固定组患者的髋关节分级问卷和EuroQol测量评分的结果最差。在随访第24个月,全髋关节置换组患者的功能结果要显著好于另外2组。尽管复位內固定组患者的初始费用最低,但是这种短期的优势会被随后与此相关的髋关节2次手术所抵消。结论:健康老年患者股骨颈移位性骨折治疗,关节置换术要比复位內固定术临床效果更佳,费用更低。长期随访表明,全髋关节置换术比半髋关节置换术更具有优势。
Objective：To investigation was to determine the functional,clinical,and resource consequences of three different types of surgical treatment.Methods：The study was a multicenter randomized controlled trial.Reduction and fixation was compared with bipolar hemi-arthroplasty and total hip replacement.Participating surgeons elected to randomize their patients to be treated with either one of the three type s of procedures or with either fixation or bipolar hemiar-throplasty.Functional outcomes were measured with a hip-rating questionnaire and the EuroQol health status measure.Clinical outcomes included mortality and complications.The direct health service costs were compared.Participants were followed up for two years.Results：Two hundred and seven patients were randomized to be treated with one of the three operations,and ninety-one were randomized to be treated with either fixation or bipolar hemiarthroplasty.There were no differences in the mortality rates among the treatment groups.The rate of secondary surgery was highest in the fixation group（39%compared with 5%in the group treated with bipolar hemiarthroplasty and 9%in the group treated with total hip re -placement）.The fixation group had the worst hip-rating-questionnaire and EuroQol scores at four and twelve months.The total hip replacement group had significantly better functional outcome scores at twenty-four months than the other two groups.Although fixation was initially the least costly procedure,this short-term advantage was eroded by significantly higher costs for subsequent hip -related hospital admissions.Conclusion：Arthroplasty was more clinically effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip.The long-term results of total hip replacement may be bet-ter than those of bipolar hemiarthroplasty.
出处
《中国伤残医学》
2013年第6期7-11,共5页
Chinese Journal of Trauma and Disability Medicine
关键词
股骨颈骨折
复位内固定
半髋关节置换
全髋关节置换
Femoral neck fracture
Reduction and fixation
Bipolar hemiarthroplasty
Total hip replacement
