| Objective Compare hollow screw,femur locking plate,Artificial femoral head replacement and Artificial total hip replacement in elderly Garden? total hip femoral neck fracture,in order to better guide the elderly Garden? of femoral neck fracture.Methods From January 2009-2014 January retrospectively analyzed of 123 cases of femoral neck fracture of Garden? of patients,coming from the Second Affiliated Hospital of Zhejiang Chinese Medical University;six cases can not continue to follow-up due to the death,which occurred more than a year after surgery,no direct relationship with the fracture or surgery.For other reasons lost eight cases;the remaining cases were followed up 109 cases with complete data.For these 109 cases of femoral neck fracture,we surgery time,incision length,blood loss,transfusion number of cases,blood transfusion,etc.,as well as the average postoperative ambulation time,incidence of postoperative complications,reoperation rate,postoperative fracture aspects of radiological evaluation recovery after 1 year and 1.5 years,Harris score excellent rate were compared.Results 1.The mean operative time was cannulated screw group of patients(0.6±0.1)h,the average length of the incision(6.0 ±0.3)cm;mean postoperative ambulation time(20 ±1.2)d,the number of cases is zero blood transfusion,blood loss(82 ±12.5)ml,blood transfusion 0,after 1 year and 1.5 years in the Harris score excellent rates were 57.14%,53.57%;proximal femoral locking plate group of patients with mean operative time was(0.7 ±0.2)h,The average incision length(7.1±0.2)cm,mean postoperative ambulation time(18±10.8)d,the number of cases is zero blood transfusion,blood loss(88.4 ±11.0)ml,blood transfusion 0,after 1 year and 1.5 Harris score good rate were 57.69%,26.92%;mean operative time hemiarthroplasty group of patients is(0.7±0.3)h,the average length of the incision(8.1±0.1)cm,mean postoperative ambulation time(10±0,9)d,the number of cases is 22 transfusion,blood loss(302.7±18.3)cm,blood transfusion(200±20.1)ml,after 1 year and 1.5 years in the Harris score good rate 77.78%,respectively,62.96%;mean operative time total hip replacement patients is(0.8±0.1)h,the average length of the incision(8.7±0.2)cm,mean postoperative ambulation time(14±1.4)d,the number of cases of transfusion is 25h,blood loss(480.6 ± 25.9)cm,blood transfusion(400 ± 42.5)ml,after 1 year and 1.5 years in the Harris score excellent rates of 89.29%,82.14%respectively.2.The mean operation time by four groups,the average length of the incision,the average difference in postoperative ambulation time,comparison of the t-test,p>0.05,not statistically significant.The average operative time patients cannulated screw shortest average operation time total hip replacement patients longest;average meision group were cannulated screw length of the shortest,longest average incision total hip arthroplasty patients length;half of the hip The mean postoperative amebulation arthroplasty shortest postoperative ambulation hollow screw group,the average longest.The number of cases by four groups of transfusion,blood loss,blood transfusion because of not normally distributed,the line-rank test,p>0.05.not statistically significant.By rank sum test,and four groups of patients after 1.5 years after hip limb function has an excellent rate,a significant difference,good rate of total hip replacement patients was significantly higher than the other three groups,hollow screw group patients with the lowest rate of the fine,which is the blood supply to the femoral head and limb surgery on the degree of influence of a great relationship.3.Locking plate fixation group was not only the highest overall postoperative complication rate(26.92%),but alsoneeding a second surgery in patients up to seven cases,secondary surgery rate(26.92%),because of severe postoperative complications of broken plate,and screws aside,etc;artificial femoral head replacement and artificial total hip replacement were because of the change with the femoral head,so their osteonecrosis were 0,artificial femoral head replacement of overall complication rate was mainly revision surgery,at least(14.29%),which recoperation rate is the lowest,this study only one patient,which reoperation rate of 3.57%.Conclusion 1.Four surgical approach in the treatment of femoral neck fractures have significant clinical effects,can significantly improve the patient's hip joint function,improving the quality of life of older people,but it should be a reasonable choice of applications based on the specific circumstances of the patient.2.Compression screw has a strung anti-reverse,simple operation,small trauma,short of surgery time,the advantages of low cost,wide range of indications.if the age below of 65 fresh fractures in clderly patients and their families are reluctant arthroplasty in particular the base or intercalation fractures,we should use hollow compression screw fixation;locking plate internal fixation can provide a strong supporting role,which can leave a gap between the plate and the periosteum,reducing the fracture fragments affect of the blood supply,reducing the screws aside,for patients with osteoporosis,which has obvious advantages than simply cannulated screw fixation surgery:for under the head type or displaced by severe neck fractures,severe osteoporosis the existence of loose who fixation possibility nonunion or avascular neerosis,we should adopt arthroplasty.3.The choice of artificial joint replacement,which needs combined with patient's age,fracture type,operation tolerance and osteoporosis.FHA applies to more than 75-year-old chronic diseases,small activity,poor body condition,surgery intolerance of elderly patients.THA is suitable for most of the elderly femoral neck fracture,no surgical contraindications,and good physical condition of Garden ??? type fracture,or of old femoral neck fracture,especially the head or neck type of choice for femoral neck fracture.4.Patients over 60 years of age were treated according to their different circumstances,which should be considered in patients over 70 years of artificial joint replacement,ptients over the age of 75 should be considered purely hemiarthroplasty,for 60 to 70 year-old patient,the fixation is suitable for those who have a higher bone density functional requirements and basic normal patients.The prosthesis is suitable for those features do not ask,and other chronic diseases in patients with poor bone quality. |
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