双动股骨头置换术治疗高龄股骨粗隆间骨折的临床研究  

Clinical Research on Bipolar Femoral Head Replacement in Treatment of Femoral Intertrochanteric Fracture in Elderly

作　　者：王正悦 王黎明[2] 姚庆强[2] 桂鉴超[2] 徐燕[2] 

机构地区：[1]江苏省南京市浦口中心医院骨科,210006 [2]南京医科大学附属南京第一医院骨科

出　　处：《中国骨与关节损伤杂志》2009年第9期775-777,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的对比双动股骨头置换(BFHR)与动力髋螺钉(DHS)治疗高龄股骨粗隆间骨折的临床结果,并分析高龄股骨粗隆间骨折行双动股骨头置换术的要点。方法收治70岁以上高龄股骨粗隆间骨折72例,其中采用DHS治疗42例(DHS组),BFHR治疗30例(BFHR组)。记录手术时间、术中术后出血量、下床活动的时间、Harris评分以及术后并发症。结果随访11～25个月。BFHR组手术时间、术中出血量、术后主动直腿抬高角度与DHS组无明显差异(P>0.05)。BFHR组术后下床时间短,术后1、6周Harris评分高,但3个月、6个月的评分两组无显著性差异。术后早期并发症发生率BFHR组低,但远期髋关节疼痛的发生率BFHR组高于DHS组。结论高龄股骨粗隆间骨折是BFHR术的可能适应证,BFHR手术对患者的影响与DHS无明显差异,BFHR优势在于术后近期恢复好,但远期效果不及DHS。Objective To investigate and discuss the feasibility and clinical outcome of bipolar femoral head replacement （BFHR） in the treatment of femoral intertrochanteric fracture in the elderly, and analyze the two operation methods： BFHR and dynamic hip screw fixation （DHS）. Methods Seventy-two patients were divided into two groups randomly. In DHS group, 42 patients were operated. In BFHR group, 30 were operated with lateral approach. Time of operation, the intra- and post -operative blood loss, the time to leave bed were recorded. Harris score in 1 week, 6 week, 3 months and 6 months postoperatively were assessed. Results The patients were followed up from 11 to 25 months with an average of 18 months. The time of operation in group of BFHR was 55±9 min （48-81 min）, while in group of DHS was 53±27 min, P〈0.05,the intra-operative blood loss in these was 200±57 （ml）, 241±67 （ml）,P〈0.05. The patients in the BFHR group could usually perform the straight leg raises actively on the fourth postoperative day, and the earliest time to leave bed was shorter in the BFHR group than in the DHS group. The Harris score of hip joint at 1 week and 6 week post-operation was higher in the BFI-IR group than in the DHS group, but at 3 months, and 6 months, the score of the two groups had no significnat difference. Conclusion Less early complications happen in the BFHR group than in the DHS group,but more patients suffer future hip pain in BFHR group than in the DHS group.

关 键 词：股骨粗隆间骨折 双动人工股骨头 动力髋螺钉 高龄 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]