分析人工关节置换手术治疗伴有偏瘫的股骨颈骨折患者的疗效。

收集肇庆市高要区人民医院2010年1月至2015年12月，采用人工关节置换治疗股骨颈GardenⅢ、Ⅳ骨折病历，回顾住院病历资料及随访资料，纳入骨折前具有一定行走能力，患髋外展肌力大于Ⅲ级患者，排除病理性骨折患者，依据患者既往史及受伤前活动能力，将患者分为偏瘫组及非偏瘫组，比较两组患者的年龄、住院时间、手术时间、手术出血量、围手术期并发症、术后第1次下地时间、早期并发症和患者活动能力恢复情况。其中年龄、手术时间、出血量、术后第1次下地时间、住院时间等计量资料比较采用独立样本t检验，性别、围手术期并发症、术前活动能力、术后活动能力恢复情况及早期并发症等计数资料比较采用卡方检验。

本研究共纳入符合条件患者121例，其中偏瘫组患者31例，无偏瘫组患者90例。偏瘫组随访25例，6例失访，非偏瘫组随访70例，失访20例，随访。两组患者的年龄(P>0.05)、手术时间(P>0.05)、围手术期并发症(P>0.05)、手术出血量(P>0.05)、术后第1次下地时间(P>0.05)、早期并发症(P>0.05)无明显差异；两组患者住院时间(t ＝3.8620，P<0.05)、活动能力恢复情况(χ²＝4.6781，P<0.05)差异有统计学意义。

伴有偏瘫的股骨颈GardenⅢ、Ⅳ型骨折患者行人工关节置换手术是积极而且有效的治疗方法，但偏瘫患者住院时间较长，且术后有活动能力下降发生率较高。

To analyze the effect of artificial joint replacement surgery in patients with femoral neck fracture associated with hemiplegia.

The relevant data of patients with Garden III and IV fractures of femoral neck who were treat with artificial joint replacement from January 2010 to December 2015 were collected. The hospital records and follow-up data were reviewed. All the patients with hip abductor muscle strength greater than grade III had a certain ability to walk before fracture, excluding pathological fractures. Based on the ability of pre-injury ambulatory status, the patients were divided into hemiparesis group and non-hemiparesis group. The age, hospitalization time, operation time, blood loss, perioperative complications, functional exercise for the first time after operation and recovery of activity ability were compared. The measurement data including age, operative time, blood loss, functional exercise for the first time after operation, and hospitalization time were compared using independent sample t-test, and the count data were compared using Chi-square test.

A total of 121 eligible patients were enrolled in this study, including 31 patients with hemiplegia and 90 patients without hemiplegia. Twenty-five cases in the hemiplegia group and 70 cases in the non-hemiplegia group were followed up. There was no significant difference in age, operation time, peri-operative complications, blood loss, functional exercise for the first time after operation, or early complications between the two groups(all P>0.05). There were significant differences between the two groups in hospitalization time(t=3.8620, P<0.05) and the recovery of the activity ability(χ²=4.6781, P<0.05).

Artificial joint replacement is an effective treatment in the patients with Garden type III and type IV fractures of femoral neck with hemiplegia, but the patients may have a longer hospital stay and a higher incidence of decreased activity after operation.