广州医科大学学报

目的 :探讨超高龄股骨颈骨折的最佳手术治疗方法。方法 :回顾性分析 1994年 1月 - 2 0 0 3年 6月 ,177例 75～ 92岁股骨颈骨折病例的临床资料 ,其中 35例接受全髋关节置换术 ,10 0例接受人工股骨头置换术 ,4 2例接受内固定术 ,比较 3种术式治疗股骨颈骨折的手术时间、手术的出血量、住院时间、负重时间、早期和中远期并发症及疗效。结果 :3种术式早期和中远期并发症均较低 ,无死亡病例。经随访并参照Harris评定标准 ,全髋关节置换组、人工股骨头置换组和内固定术组优良率 97.1%、78.7%和 80 .5 % ,并发症发生率无显著性差异 (P >0 .0 5 )但疗效有显著性差异 (P <0 .0 5 )。结论 :GardenⅠ -Ⅱ型头下型和经颈型 ,Ⅰ -Ⅲ型基底型 ,在优良复位的前提下行坚强的内固定治疗 ;GardenⅢ -Ⅳ型头下型和经颈型 ,Ⅳ型基底型的患者 ,行全髋关节置换术或行人工股骨头置换术。

Objective:To explore the best surgical methods in the treatment of femoral neck fractures in the superelderly patients. Methods :One hundred and seventy-seven patients of femoral neck fractures aged 75 to 92 years from January 1994 to June 2003 were analyzed retrospectively, of which 35 cases underwent total hip replacement(THR)(Group A), 100 cases hemiarthroplasty(Group B) and 42 cases internal fixation(Group C) . Duration of hospitalization, blood loss at surgery, complications of early or middle-late stage and results of the treatment were compared among three groups. Results:There were few complications and no dead cases among three groups. By follow-up and reference to the Harris evaluation standard, the excellent rate of the joint function was 97.1% in Group A, 78.7% in Group B and 80.5% in Group C. And the rate of complication was not remarkable(P>0.05).But the result of the treatment was a significant different among the three groups. Conclusion: When treating the patients of subcapital, transcervical (Graden Ⅰ,Ⅱ),basic(GradenⅠto Ⅲ) femoral neck fractures, internal fixation should be the first choice under the excellent relocation ; THR and hemiarthroplasty are suitable for the patients of subcapital, transcervical (Graden Ⅲ,Ⅳ) and basic(GradenⅣ) femoral neck fractures .