Comparison Of The Clinical Curative Effect Of Three Surgical Methods For Femoral Neck Fractures In The Elderly

[Objective]The clinical curative effect of three treatment methodsincluding total hip replacement,artificial femoral head replacement and multi-screw internal fixationwas was comparedin elderly patients with femoral neck fractureso as to provide guidance for clinical treatment of such patients.[Methods]The clinical data of 120 patients with femoral neck fractures who were admitted to the hospital from January 2010 to November 2015 were collected.The patients were divided into the total hip replacement group(group A),artificial femoral head replacement group(group B)and multi-screw internal fixation group(group C)according to different surgical methods.The surgical conditions of the three groups were compared,including the mean surgical time,average intraoperative blood loss,average intraoperative blood transfusion volume and average number of cases receiving blood transfusion.The hospitalization indicators were statistically analyzed,including the average hospitalization time,average hospitalization costs,average postoperative weight-bearing time,average postoperative ambulation time,Harris hip function score and Perceptions and Function score.The perioperative systematic complications and the incidence of local complications of the affected hip during the follow-up period were compared.Not only that,causes were exploded,and the reoperation rate was statistically analyzed.[Results]All of the patients were followed up for 24 months.Among them,there were 4 cases in group A and 2 case in group B lost to follow-up while all patients in group C were followed up.The surgical time of group A was significantly longer than that of group B or group C(P<0.05),and the surgical time of group C was significantly shorter than that of group B(P<0.05).There was no significant difference in the intraoperative blood loss between group A and group B(P>0.05),but the surgical time and intraoperative blood loss of group C were significantly shorter/less than those of group A or group B(P<0.05).There was no significant difference in the hospitalization time or postoperative ambulation time between group A and group B(P>0.05).However,the hospitalization time and hospitalization costs of group C were significantly shorter/less than those of group A and group B,while the postoperative ambulation was significantly longer than that of group A and group B(P<0.05).The Harris scores at 6 months and 24 months after surgery showed group A>group B>group C,with significant differences between groups(P<0.05).At 6 months after surgery,scores of nighttime pain influencing sleep and bathing difficulty in group A were significantly lower than those in group B and group C(P<0.05).The number of lameness caused by pain was significantly lower in group A and B than in group C(P<0.05).At 24 months after surgery,score of nighttime pain influencing sleep in group A was significantly lower than that in group B and group C(P<0.05).There was no significant difference in score of lameness because of pain when walking,standing pain after meal,bathing difficulty and influencing work because of pain(or housework)among the three groups(P>0.05);There was no significant difference in incidence of perioperative complications among group A,B and C(P>0.05).During the follow-up period,there was no significant difference in incidence of complications between group A and group B(2.2%vs 2.6%)(P>0.05),but the incidence rate in group C(20.0%)was significantly higher than that in group A and B(P<0.05).[Conclusions]All of total hip replacement,artificial femoral head replacement and multi-screw internal fixation can effectively improve the function of the affected limb of patients with femoral neck fractures.The duration of joint replacement is relatively longer and the hospitalization costs is relatively more.The multi-screw internal fixation does not increase the short-term complications,but its long-term curative effect is not so good as joint replacement.To improve the quality of life of elderly patients with femoral neck fractures,joint replacement is recommended.For patients with long life expectancy,many activities and good condition,total hip replacement is recommended.