分析老年股骨颈骨折患者首次全髋关节置换术(THA)的近期疗效及影响因素。

收集四川绵阳四0四医院2013年1月至2018年12月121例老年股骨颈骨折患者首次全髋关节置换术患者资料，术后6个月采用Harris髋关节评分评价近期疗效，以髋关节恢复良好与恢复不良分为两组。对可能影响疗效的因素采用单因素分析，有统计学意义的因素进一步采用二分类logistic回归分析。

121例老年股骨颈骨折患者THA后优41例，良58例，可16例，差6例，优良率81.82%。预后优良组与预后不良组患者合并内科疾病、手术时间、失血量、术后康复介入时间、并发症构成比例差异有统计学意义(χ²＝1.597、U＝4.276、χ²＝7.894、U＝11.408、F＝8.223，均为P<0.05)。Logistic回归分析显示，康复介入时间≥11 d、术后并发症、肥胖、失血量≥300 ml是影响老年股骨颈骨折患者THA术预后的危险因素[比值比(OR)＝1.993，2.508，1.249，1.809；95%置信区间(CI)：(2.261，5.027)，(1.073，5.834)，(1.047，2.859)，(1.613，9.726)，均为P<0.05]。

老年股骨颈骨折患者THA后近期疗效肯定。影响疗效的因素有康复介入时间晚、术后发生并发症、肥胖、失血量大，在围术期应积极防治。

To analyse the short-term therapeutic efficacy and influencing factors of the primary total hip arthroplasty (THA) in elderly patients with femoral neck fracture.

Data of 121 elderly patients with femoral neck fracture who received total hip replacement for the first time in Sichuan Mianyan 404 Hospital, from January 2023 to December 2018, were collected. Harris hip score evaluation was used at six months after surgery to evaluate the short-term therapeutic effects. The patients were assigned into a good recovery group and a poor recovery group. Single factor analysis was used to analyse the factors that would affect the therapeutic effect. Binary logistic regression was used to analyse the factors with statistical significance.

After THA for 121 femoral neck fractures in elderly patients, there were 41 patients in excellent, 58 in good, 16 in fair and six in poor, with 81.82% in excellent and good. There were statistically significant differences in the patients with underlying diseases, surgical time, amount of blood loss, duration of postoperative rehabilitation and complications, between the patients in the good recovery group and poor recovery group (χ²=1.597, U=4.276, χ²=7.894, U=11.408, F=8.223, all P<0.05). Logistic regression analysis showed that rehabilitation duration ≥11 days, postoperative complications, obesity, and amount of blood loss ≥300 ml were the risk factors that affected the recovery from THA in elderly patients with femur neck fractures [odds ratio (OR)=1.993, 2.508, 1.249, 1.809; 95% confidence interval (CI): (2.261, 5.027), (1.073, 5.834), (1.047, 2.859), (1.613, 9.726), all P<0.05].

The short- term curative effect on THA in elderly patients with femoral neck fracture is affirmative. The factors that influences the recovery from THA include duration of rehabilitation, postoperative complications, obesity and large amount of blood loss. The identified influencing factors should be actively prevented and managed through perioperative period.