课题背景：高龄股骨颈骨折患者多采用人工髋关节假体置换治疗，但全髋关节假体置换手术创伤大，患者手术风险较高。吉林大学第一医院骨关节一科谷贵山教授首次将POSSUM和P－POSSUM评分系统引入国内骨科领域，评估老年股骨颈骨折的手术风险，指导治疗，并取得了一定的成果。

相关链接：国外多数学者认为全髋置换的中远期效果要优于人工双极股骨头置换，因此在患者全身状态允许的情况下应首选全髋关节置换。而对于高龄股骨颈骨折这样一个手术风险较大的人群，做好术前风险评估和充分准备就显得尤其重要。

偏倚或不足：本文为单中心回顾性分析，有必要在下一步的实验中进行前瞻性研究，更有说服性。

摘要
目的：高龄股骨颈骨折患者在人工全髋假体和人工双极股骨头假体置换的选择上存在争议。回顾性分析全髋关节假体置换与人工双极股骨头假体置换治疗70岁以上股骨颈骨折远期生物相容性反应及关节功能恢复状况。
方法：2002-01/2006-12吉林大学第一医院骨关节一科收治的70岁以上股骨颈骨折实行髋关节置换的患者60例60髋。按照手术方式分为人工全髋置换组和人工双极股骨头置换组。全髋关节置换组21例，男8例，女13例，平均年龄（72.1±3.5）岁，合并内科疾病18例。人工双极股骨头置换组39例，男16例，女23例，平均年龄（75.1±6.4）岁，合并内科疾病35例。①人工假体选择：16例假体采用德国Link公司及美国Zimmer公司产品，44例为北京蒙太因公司提供的人工关节。②术者资质：手术均由本科从事人工关节专业工作≥ 10年高年资医师作为术者完成，术者资格符合岗位技术标准要求。③置入后评估：全部病例平均随访37个月，从材料与宿主的生物相容性、关节功能、Harris评分、住院时间、住院费用、不良反应、手术时间、术中出血量等方面进行比较和随访。
结果：①材料与宿主生物相容性的比较：人工双极股骨头置换组2例患者在术后5年出现髋臼壁磨损而行翻修手术。其余患者无切口感染，无关节脱位，无假体松动。②两组不良反应比较：全髋关节置换组和人工双极股骨头置换组各有1例在术后出现患侧髋部红肿、疼痛，经证实无假体周围感染，对症治疗后痊愈。③关节功能随访比较：平均随访37个月，全髋关节置换组Harris评分平均为（89.8±8.6）分，人工双极股骨头置换组Harris评分平均为（72.7±9.5）分，两组比较差异有显著性意义（P < 0.05）。④住院时间与住院费用的比较：两组患者平均住院时间和平均住院费用相比差异无显著性意义（P > 0.05）。⑤手术时间与术中出血量的比较：全髋关节置换组平均手术时间（150.2±24.3）min，人工双极股骨头置换组平均手术时间（105.8±22.1）min，两组相比差异有显著性意义（P < 0.05）。全髋关节置换组平均术中出血（990.1±184.6）mL，人工双极股骨头置换组平均术中出血量（680.5±154.7）mL，两组相比差异有显著性意义（P < 0.05）。
结论：高龄股骨颈骨折行人工全髋关节置换后关节功能恢复较好，远期出现髋关节疼痛及髋臼磨损等生物相容性反应的几率较低，是人工关节置换治疗的首选方法。
关键词：人工全髋关节置换；人工双极股骨头置换；股骨颈骨折；老年；人工假体；生物相容性

张德宝，王铁军，谷贵山.高龄股骨颈骨折患者行全髋关节置换与人工双极股骨头置换的比较[J].中国组织工程研究与临床康复，2008，12(9):1651-1654 [www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1651(ps).pdf]

Comparison of total hip replacement and bipolar artificial femoral head replacement for elderly patients with femoral neck fractures

Abstract
AIM: There is a controversial argument about the choice of total hip replacement (THR) and bipolar artificial femoral head replacement (FHR) for elderly patients with femoral neck fracture. This study was designed to explore the long-term biocompatibility and functional recovery of joints in patients over 70 years with femoral neck fracture by THR and bipolar artificial FHR.
METHODS: Sixty patients with femoral neck fracture over 70 years were enrolled from the First Department of Bone and Joint Surgery in the First Hospital of Jilin University from January 2002 to December 2006. There were 21 cases (8 males and 13 females) receiving THR, with a mean age of (72.1±3.5) years, and 18 of them were complicated with internal diseases. While 39 cases (16 males and 23 females) received bipolar artificial FHR, their average ages was (75.1±6.4) years, and 35 of them were complicated with internal disease. ①Choice of artificial prosthesis: Sixteen prosthesis were produced by Germany Link Company and American Zimmer Company, 44 artificial joints were offered by Beijing Mengtaiyin Medical Instrument Co., Ltd. ②All the patients were operated by senior doctors who were qualified for post technique owing to more than 10-years working experience about artificial joints. ③The mean time of follow-ups for all patients was 37 months. The difference was compared in biocompatibility between materials and host, joint function, Harris scoring, time of operation, blood loss, time of hospitalization, cost of hospitalization and adverse effect.
RESULTS: ①Comparison of biocompatibility: Two revisions for abrasion of acetabular wall were carried out 5 years after bipolar artificial FHR, and there was no infection of incision, dislocation of hip joint or loose of artificial joint in other patients of these two groups. ②Comparison of adverse effect: There was one patient with complications of pain and red swelling of hip in each group. No infection occurred around the prosthesis, and these two patients recovered after symptomatic treatment. ③Comparison of follow-ups for joint function: The average Harris scores was 89.8±8.6 in THR group and 72.7±9.5 in bipolar artificial FHR group, and there were significant differences in these two groups (P < 0.05). ④There was no significant difference between two groups in the comparison of time and cost of hospitalization (P > 0.05). ⑤Comparison of operation time and blood loss: The average operation time were (150.2±24.3) minutes in THR group and (105.8±22.1) minutes in bipolar artificial FHR group, with significant differences (P < 0.05). The blood loss was (990.1±184.6) mL in THR group and (680.5±154.7) mL in bipolar artificial FHR group, with significant differences (P < 0.05).
CONCLUSION: With the low occurrence of biocompatibility reactions such as pain and abrasion of acetabular wall in long-term observation, and good functional recovery of joints, THR is the best treatment in elderly patients with femoral neck fractures.

Zhang DB, Wang TJ, Gu GS.Comparison of total hip replacement and bipolar artificial femoral head replacement for elderly patients with femoral neck fractures. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(9):1651-1654(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1651(ps).pdf]