3种方法治疗老年不稳定性股骨转子间骨折的疗效比较  

Comparison efficacy of the treatment of the unstable intertrochanteric fractures in elderly patients with three different kinds of operation

作　　者：彭涛[1] 寿康全[1] 付纳新[1] 黄晖[1] 

机构地区：[1]三峡大学第三临床医学院骨外科,河北宜昌443002

出　　处：《临床骨科杂志》2015年第2期187-190,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较人工关节置换与髓内、外固定治疗老年不稳定性转子间骨折的疗效。方法手术治疗70例老年不稳定性股骨转子间骨折患者,根据手术方式不同分为股骨近端防旋髓内钉（PFNA）组（21例）、锁定钢板组（30例）以及人工关节组（19例）。对3组手术时间、术中出血量、住院时间、骨折相关并发症、术后深静脉血栓和肺部感染发生率以及术后12、24个月髋关节功能评分等资料进行比较。结果 70例患者均获得随访,时间24~50个月。PFNA组的手术时间（61.4 min±10.2 min）、术中出血量（196 ml±64.1 ml）均少于另两组（P〈0.05）。人工关节组的住院时间（16.3 d±3.9 d）、骨折相关并发症（5.2%）、术后深静脉血栓（5.3%）、肺部感染（10.5%）发生率均少于另两组（P〈0.05）,术后12个月髋关节Harris评分优良率（84.2%）高于另两组（P〈0.05）。术后24个月髋关节Harris评分优良率3组比较差异无统计学意义（P〉0.05）。结论对于老年不稳定性股骨转子间骨折,人工关节置换术在改善近期髋关节功能及降低术后并发症上更有优势。Objective To compare the clinical effects of total hip arthroplasty（ THA） and internal fixations on unstable intertrochanteric hip fractures in elderly patients. Methods 70 cases with unstable intertrochanteric hip fractures were treated with three kinds of operation： proximal femoral nail anti-rotation（ PFNA,n = 21）,locking proximal femur plate（ LPFP,n = 30） and THA（ n = 19）. The data of each group were collected for statistical analysis on the following aspects： operative time,blood loss,hospital stays,fracture-related complications,the morbidity of DVT and rate of pulmonary infection,the Harris scores of the 12,24 months after the operation respectively. Results All 70 cases were followed up for 24 ~ 50 months. In comparing with group LPFP and THA,group PFNA showed less operation time（ average 61. 4 min ± 10. 2 min） and blood loss（ average 196 ml ± 64. 1 ml）（ P〈0. 05）. Comparing with group PFNA and LPFP,group THA showed shorter hospital stays（ average 16. 3 d ± 3. 9 d）,less complications（ 5. 2%）,lung infection rate（10. 5%） and better result of the excellent and good rate of Harris scores（ 84. 2%） of the 12 months after the operation than the other groups（ P〈0. 05）. And there were no significant difference among the three groups referring to the Harris scores of 24 months after the operation（ P〉0. 05）. Conclusions Generally,THA is a better treatment for the unstable intertrochanteric hip fracture patients on the improvement of short term post-operative restored function and reduction of post-operative complications

关 键 词：转子间骨折 人工关节置换 内固定 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]