49例老年髖部骨折患者的手術治療及預后評估研究

張富財 鄭峰 王福榮 李沛

[摘要] 目的 探討老年髖部骨折患者的手術治療效果及預后情況。 方法 選擇我院2017年3月～2018年9月收治的98例患者隨機分為觀察組（n=49）和對照組（n=49）。對照組患者給予常規保守牽引治療，觀察組給予手術治療。觀察比較兩組臨床療效、髖關節功能Harris評分及術后并發癥發生情況。 結果 觀察組優良率為89.80%高于對照組的79.59%，但差異無統計學意義（χ2=1.968，P=0.161）;兩組療效整體比較，差異有統計學意義（Z=-6.928，P=0.000）。治療后，兩組Harris評分與治療前比較均顯著升高，差異有統計學意義（t=-18.663，P=0.000; t=-15.682，P=0.000）;且治療后觀察組Harris評分（88.47±15.84）分顯著高于對照組（81.36±12.56）分，差異有統計學意義（t=2.462，P=0.016）。觀察組術后并發癥發生率4.08%顯著低于對照組的16.33%，差異有統計學意義（χ2=4.009，P=0.045）。 結論 手術治療老年髖部骨折臨床療效顯著，可有效改善患者髖關節功能，減少并發癥，提高患者生活自理能力及生活質量，值得推廣應用。

[關鍵詞] 髖部骨折;老年;髖關節功能;保守牽引;人工關節置換術

[中圖分類號] R683.3? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2019）19-0095-03

[Abstract] Objective To investigate the surgical treatment effect and prognosis of elderly patients with hip fracture. Methods 98 patients admitted in our hospital from March 2017 to September 2018 were randomly divided into observation group（n=49） and control group（n=49）. Patients in the control group were given conventional conservative traction therapy and the observation group was given surgery. The clinical efficacy， hip function Harris score and postoperative complications were compared between the two groups. Results The excellent and good rate of the observation group was 89.80%， higher than that of the control group（79.59%）. There was no significant difference between the two groups（χ2=1.968， P=0.161）. There was a statistically significant difference in the overall effect between the two groups（Z=-6.928， P=0.000）. After treatment， the Harris scores of the two groups were significantly higher than those before treatment， and the difference was statistically significant（t=-18.663， P=0.000; t=-15.682， P=0.000）. And the Harris score of the observation group was 88.47±15.84 after treatment， significantly higher than（81.36±12.56） of the control group， and the difference was statistically significant（t=2.462， P=0.016）. The postoperative complication rate of the observation group was 4.08%， significantly lower than that of the control group（6.33%）， and the difference was statistically significant（χ2=4.009， P=0.045）. Conclusion Surgical treatment of elderly hip fracture has a significant clinical effect， which can effectively improve hip function， reduce complications， improve patient self-care ability and quality of life， and is worthy of popularization and application.

[Key words] Hip fracture; Elderly; Hip function; Conservative traction; Artificial joint replacement

髖部骨折是臨床骨科常見疾病、發病率，其傷殘率及死亡率均較高[1]。髖部骨折好發于老年人群，考慮與老年人群性激素水平下降、免疫功能下降、骨質退化、骨脆性增加、骨質疏松及運動肢體機能退化等有關，導致骨折風險明顯升高[2]。近年來，隨著社會老齡化的不斷加重，老年髖部骨折發生率逐年上升，嚴重影響患者生存質量[3]。

臨床中對于老年髖部骨折的治療，以減少患者疼痛、恢復髖關節功能以及減少臥床等并發癥等為主要治療原則[4]。……