Abstract：Objective To compare the efficacy of screw fixation, femoral head replacement and total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in the elderly.Methods The clinical data of 280 elderly patients with displaced femoral neck fractures from May 2013 to May 2018 in Peace Hospital Affiliated to Changzhi Medical College were retrospectively analyzed. According to the different surgical methods, 76 cases were treated with screw fixation in group A, among them, there were 32 males and 44 females, with the average age of (70.95±8.24) years old. And 92 cases with replacement of femoral head in group B, among them, 40 males and 52 females, with the average age of (72.84±9.14) years old. And 112 cases with THA in group C, among them, 59 were males and 53 were females, with the average age of (73.05±7.21) years old. The general data, intraoperative bleeding volume, operation time, complications and Harris score of hip function after surgery were compared among the three groups.Results Intraoperative blood loss, operation time and fracture healing time in group A were (95.05±20.14) mL, (47.06±10.14) min and (6.64±1.74) months, respectively. In group B, they were was (208.74±60.15) mL, (82.55±15.47) min and (5.01±1.25) months, respectively. In group C, they were (337.69±85.13) mL, (97.85±12.04) min and (4.36±1.04) months, respectively. In the comparison of intraoperative hemorrhage and operation time, group B and C were greater than group A, group C was greater than group B; in the comparison of fracture healing time, group B and group C were shorter than group A, and group C was shorter than group B; the difference was statistically significant (all P values＜0.05). All the patients were followed up for 12-60 (39.45±8.25) months. The incidence of complications in group B (20.65%, 19/92) and group C (16.07%, 18/112) were lower than that in group A (38.16%, 29/76), the difference was statistically significant(all P values＜0.05), but there was no significant difference between group C and group B (P＞0.05). Twelve months after operation, Harris score was used to evaluate the hip joint function. The excellent and good rates of group A, B and C were 63.14% (48/76), 75.00% (69/92) and 83.93% (94/112), respectively. The excellent and good rates of group C were significantly higher than those of group A (P＜0.05), but there was no significant difference between group B and group A, C (all P values＞0.05).Conclusions For elderly patients with displaced femoral neck fractures, appropriate and safe surgical procedures should be selected with comprehensive consideration of the patient's physical tolerance, personal intention and other factors. THA is suitable for patients with relatively good physical condition and high mobility requirements, and the effect of THA is better than that of femoral head replacement and compression screw fixation.
石斌, 李宏倬, 牛建民, 裴卫卫, 孙长英. 螺钉内固定、股骨头置换与全髋关节置换治疗老年移位型股骨颈骨折的疗效比较[J]. 中华解剖与临床杂志, 2019, 24(6): 577-582.
Shi Bin, Li Hongzhuo, Niu Jianmin, Pei Weiwei, Sun Changying. Comparison of screw fixation, femoral head replacement and total hip replacement in the treatment of displaced femoral neck fractures in the elderly. Chinese Journal of Anatomy and Clinics, 2019, 24(6): 577-582.
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2019, Vol. 24 
