Retrospective Analysis Of Different Surgical Outcomes In Elderly Patients With Femoral Neck Fractures (Garden Ⅲ, Ⅳ)

Objectives Comparative analysis of total hip arthroplasty,bipolar artificial femoral head replacement and cannulated screw internal fixation for the treatment of femoral neck fractures(Garden Ⅲ,Ⅳ).And to explore the changes in postoperative anatomical parameters of patients and whether it has an impact on postoperative hip joint function.Methods A total of 109 elderly patients with femoral neck fractures admitted to the Affiliated Hospital of North China University of Technology and the Second Hospital of Tangshan from May 2014 to May 2017 were selected and screened according to screening criteria.The remaining 105 cases were valid.Case data,imaging examinations,and hospitalizations of the 105 patients were detailed and statistically and retrospectively analyzed.According to different surgical methods,the patients were divided into three groups,and 36 patients(THA group)underwent total hip arthroplasty.11 males(29.4%),25 females(70.6%);aged 65-79 years,mean(70.29±0.99)years old;21 cases of left femoral neck fracture,15 cases of right femoral neck fracture;Garden type: type Ⅲ 22 cases,14 cases of type Ⅳ.Thirty-five patients(BFHR group)underwent bipolar artificial femoral head replacement,9 males(30.8%)and 26 females(69.2%);aged 65-80 years,mean(71.21±0.75)years old;left femur There were 22 cases of neck fracture and 13 cases of right femoral neck fracture.Garden classification: 20 cases of type Ⅲ,15 cases of type Ⅳ.Thirty-four patients(HSIF group)underwent open screw internal fixation,16 males and 18 females;aged 65-78 years,mean(69.76±0.75)years;15 cases of left femoral neck fracture,right femoral neck fracture 19 example.Garden classification: 26 cases of type Ⅲ,8 cases of type Ⅳ.The perioperative index,hip function score and measured anatomical parameters of the three groups were postulated,and the data were analyzed by SPSS17.0 software.Results The time,intraoperative blood loss,hospitalization cost,Harris hip function score,Merle D’Aubign and Postel hip function scores of the three groups were statistically significant(P<0.05);hospitalization time comparison,difference There was no statistical significance(P>0.05).The operation time in the THA group was(101.85±9.40)min,the time in the BFHR group was(85.09±8.61)min,and the time in the HSIF group was(63.44±3.89)min.The difference was statistically significant(F=212.89,P< 0.05).The intraoperative blood loss in the THA group was(326.21±28.25)ml,the intraoperative blood loss in the BFHR group was(268.89±21.59)ml,and the intraoperative blood loss in the HSIF group was(107.79±10.65)ml.The difference was statistically significant(F= 949.37,P<0.05).The hospitalization cost in the THA group was(60437.17±3190.96),the hospitalization cost in the BFHR group was(48187.05±4109.68),and the hospitalization cost in the HSIF group was(23280.74±2066.74).The difference was statistically significant(F=1166.66,P<0.05).The Harris hip function score in the THA group was(93.21±7.45),the Harris hip function score in the BFHR group was(87.97±7.42),and the Harris hip function score in the HSIF group was(82.94±7.41).The difference was statistically significant.(F= 6.08,P<0.05).The Merle D’Aubign and Postel functional scores in the THA group were(16.56±2.52),the Merle D’Aubign and Postel functional scores in the BFHR group were(14.50±3.04),and the Merle D’Aubign and Postel functional scores in the HSIF group were(12.38±4.24),the difference was statistically significant(F=13.26,P<0.05).The femoral eccentricity of the THA group was(37.87±4.79)mm,and the reexamination was(35.81±4.30)mm.The difference wasstatistically significant(t=5.267,P<0.05).The femoral eccentricity of the BFHR group was(39.48±4.93)mm,and the reexamination was(36.69±4.66)mm.The difference was statistically significant(t=4.109,P<0.05).The HSIF group had a anteversion angle of(14.03±5.45)degrees and a recurrent examination of(12.59±1.02)degrees.The difference was statistically significant(t=3.095,P<0.05).There was no significant difference in the change of eccentricity between the short-term and the patient’s function after THA(c2=5.024,P>0.05).The short-term eccentricity changes and patient function after BFHR were compared,the difference was not statistically significant(c2=0.091,P>0.05).The change in anteversion angle and the patient’s function were compared in the short term after HSIF.The difference was not statistically significant(c2=0.094,P>0.05).Conclusions 1 The hip function of patients undergoing total hip arthroplasty in a short period of time is superior to bipolar artificial femoral head replacement.2 The hip function of patients with hip replacement surgery is better than that of cannulated screw fixation.3 Short-term femoral eccentricity decreased after hip replacement,but had no effect on hip function.4 The reduction of femoral anteversion was short-term after internal fixation with cannulated screws,but had no effect on hip function.Figure16;Table13;Reference 79...