目的 对比分析双极半髋关节置换术(BHA)与全髋关节置换术(THR)治疗股骨颈骨折(FNF)的效果。方法 回顾性收集北京中医药大学东直门医院洛阳医院2019年6月—2023年4月90例FNF患者临床资料,依照手术治疗方案差异分为两组,BHA组(45例)行BHA治疗,THR组(45例)行THR治疗,比较两组围术期指标、术前及术后3 d炎症因子水平、术后6个月髋关节活动度、术前及术后6个月生活质量[欧洲生活质量评分(EQ-5D评分)]。结果 THR组手术时间(108.76±15.33)min、下床活动时间(40.37±10.24)h、住院时间(19.02±5.11)d均较BHA组[(53.49±10.12)min、(25.92±7.15)h、(15.16±4.87)d]长(t分别为20.184、7.761、3.668,均P<0.05),术中失血量(318.69±35.14)mL、术后引流量(129.74±21.03)mL均较BHA组[(224.07±29.35)mL、(90.35±17.48)mL]多(t分别为13.863、9.663,均P<0.001);组间并发症发生率比较差异无统计学意义(P>0.05);术后3 d,BHA组血清白细胞介素-1为(17.35±3.06)pg/L、白细胞介素-6为(24.82±4.31)pg/L、C-反应蛋白为(26.17±4.59)pg/L,低于THR组的(20.16±3.48)pg/L、(27.04±5.06)pg/L、(28.90±5.12)pg/L(t分别为4.068、2.241、2.663,均P<0.05);两组术后6个月髋关节内旋、屈曲、外旋、外展、内收活动度及EQ-5D评分对比差异均无统计学意义(均P>0.05)。结论 与THR相比,BHA能减少FNF患者围术期失血量,降低术后炎症因子表达水平,缩短手术及下床活动时间,促进恢复。
Objective To compare and analyze the effects of bipolar hemihip replacement(BHA)and total hip replacement(THR)in the treatment of femoral neck fracture(FNF).Methods The clinical data of 90 patients with FNF in the Luoyang Hospital,Dongzhimen Hospital,Beijing University of Chinese Medicine,from June 2019 to April 2023 were retrospectively collected.The patients were divided into two groups according to the difference in surgical treatment plan.The BHA group(45 cases)received BHA treatment,and the THR group(45 cases)received THR treatment.The perioperative indicators,preoperative and postoperative inflammatory factor levels,postoperative hip joint mobility at six months,preoperative and postoperative quality of life [European Quality of Life Scale(EQ-5D score)]were compared between the two groups.Results The operation time(108.76±15.33)min,ambulation time(40.37±10.24)h,and hospitalization time(19.02±5.11)d in the THR group were longer than those in the BHA group [(53.49±10.12)min,(25.92±7.15)h,(15.16±4.87)d](t=20.184,8.630,3.668,respectively,all P<0.05).The intraoperative blood loss(318.69±35.14)mL and postoperative drainage volume(129.74±21.03)mL were both higher than those in the BHA group [(224.07±29.35)mL,(90.35±17.48)mL](t=13.863,9.663,respectively,all P<0.001).There was no significant difference in the incidence of complications between the groups(P>0.05).Three days after surgery,the serum levels of interleukin-1,interleukin-6,and C-reactive protein in the BHA group were(17.35±3.06)pg/L,(24.82±4.31)pg/L,and(26.17±4.59)pg/L,respectively,which were lower than those in the THR group(20.16±3.48)pg/L,(27.04±5.06)pg/L,and(28.90±5.12)pg/L(t=4.068,2.241,2.663,respectively,all P<0.05).There was no significant difference in the range of motion of internal rotation,flexion,external rotation,abduction,and adduction of the hip joint and EQ-5D scores between the two groups at six months after surgery(all P>0.05).Conclusions Compared with THR,BHA can reduce perioperative blood loss in FNF patients,reduce postoperative inflammatory factor expression level,shorten operation and ambulation time,and promote recovery.