目的 探讨补肾活血汤在骨质疏松性股骨颈骨折(FNF)术后愈合的应用效果,旨在为临床治疗提供参考依据。方法 选取濮阳市中医医院2019年1月—2020年1月收治的骨质疏松性FNF患者76例,依据双盲法分为观察组(38例)与对照组(38例),2组均行手术治疗,对照组术后予以常规治疗与康复训练,观察组加用补肾活血汤治疗,以30 d作为1个疗程,持续治疗3个疗程。对比2组临床疗效与术前、术后6个月骨密度值及Harris评分以及术后6个月期间并发症发生情况。结果 相较对照组,观察组临床总有效率较高,差异有统计学意义(P＜0.05);比较2组术前骨密度值无差异(P＞0.05);较术前,术后6个月2组骨密度值均上升,且观察组骨密度值较高,差异有统计学意义(P＜0.05);2组术前Harris评分对比无差异(P＞0.05);较术前,术后6个月2组Harris评分均上升,且观察组Harris评分较高,差异有统计学意义(P＜0.05);2组并发症发生率对比无差异(P＞0.05)。结论 骨质疏松性FNF患者采用补肾活血汤治疗可提升临床疗效,增加骨折处骨密度值并改善髋关节功能,促进术后愈合,值得临床推广。

目的 探究空心加压螺钉(CCS)和股骨颈系统(FNS)两种不同的内固定方法治疗60岁以下患者股骨颈骨折的疗效。方法 回顾性研究2018年1月—2019年9月期间在我院接受内固定手术治疗的100例股骨颈骨折患者,根据内固定方式不同,分为FNS组(观察组)和CCS组(对照组),比较2组患者的术后并发症、围手术期特征;并在手术前和手术后1年使用Harris髋关节评分(HHS)评估关节功能。结果 2组患者中,观察组的手术时间和围手术期出血量均大于对照组(P<0.05);术后观察组的骨愈合时间低于对照组,且观察组股骨颈短缩程度也低于对照组(P<0.05);观察组螺钉切除发生率以及术后并发症总发生率均低于对照组(P<0.05)。结论 年龄小于60岁的股骨颈骨折患者通过CCS或FNS治疗可以获得满意的临床效果。 FNS 具有优异的生物力学性能,并显示出更高的整体结构稳定性。

Objective To explore the curative effect of two different internal fixation methods, cannulated compression screw (CCS) and femoral neck system (FNS), in the treatment of femoral neck fractures in patients under 60 years old. Methods Retrospectively studied 100 patients with femoral neck fractures who underwent internal fixation surgery in our hospital from January 2018 to September 2019. According to different internal fixation methods, they were divided into FNS group (observation group) and CCS group (control group). The postoperative complications and perioperative characteristics of the two groups of patients were compared, and the Harris Hip Score (HHS) was used to assess joint function before and 1 year after the operation. Results In the two groups of patients, the operation time and perioperative blood loss of the observation group were more than those of the control group (P<0.05); the bone healing time of the observation group was shorter than that of the control group, and the degree of femoral neck shortening in the observation group was also lower than the control group (P<0.05); the incidence of screw resection and the total incidence of postoperative complications in the observation group were lower than those in the control group (P<0.05). Conclusions Patients with femoral neck fractures under 60 years old could obtain satisfactory clinical results through CCS or FNS treatment. FNS had excellent biomechanical properties and showed significantly higher overall structural stability.

目的 研究全髋关节置换术对于股骨颈骨折老年患者的适用性。方法 回顾性分析本院2012年1月—2014年1月间收治的89例股骨颈骨折老年患者,根据不同治疗术式将患者分为两组,将其中采取人工全髋关节置换术治疗的56例患者纳入全髋组,以将其中采取半髋关节置换术治疗的33例患者纳入半髋组,对比两组患者的手术情况,随访一年评估疗效并统计功能恢复时间以及并发症发生情况。结果 半髋组各项手术情况观察指标均优于全髋组,P<0.05;治疗后随访一年,全髋组总有效为96.43%,半髋组总有效率为93.94%,全髋组疗效优于对照组,P<0.05;全髋组并发症发生率为3.57%,半髋组并发症发生率为18.18%,全髋组并发症发生率优于半髋组,P<0.01。结论 全髋关节置换术治疗股骨颈骨折老年患者适用性高于半髋关节置换术,可考虑作为老年患者的首选术式加以推广。

Objective To study the applicability of total hip arthroplasty in elderly patients with femoral neck fracture. Methods A retrospective analysis of 89 cases of elderly patients with femoral neck fracture in our hospital was made from January 2012 to January 2014, according to different surgical methods. The patients were divided into two groups, among them 56 cases of total hip arthroplasty were in the total hip group, and 33 cases of hip replacement were in the semi hip arthroplasty group. To compare the surgery condition, one year of follow-up evaluation of occurrence curative effect was made and added up the function recovery time and complications in the two groups. Results The surgical observation indicators in the semi arthroplasty group were better than the total hip group, P<0.05; follow-up one year after the treatment, the total effective rate of the total hip group was 96.43%, that in the semi hip arthroplasty group was 93.94%, thus the curative effect of the total hip group was better than the control group, P<0.05; The incidence of complications of the total hip arthroplasty group was 3.57%, that in the semi hip arthroplasty group was 18.18%, thus the incidence of complications of the total hip group was better than the semi hip group, P<0.01. Conclusion The adaptability of the total hip arthroplasty in the treatment of elderly patients with femoral neck fractures is better than the semi hip replacement surgery, and it may be considered as the first choice for the elderly patients to promote.

       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．