人工全髋关节置换术与内固定治疗老年不稳定性股骨转子间骨折对比研究  

Comparative study of total hip arthroplasty and internal fixation for elderly patients with unstable intertrochanteric fractures

作　　者：贾德卫[1] 邵明[1] 凌坤[1] 邱伟[1] 余利民[1] 

机构地区：[1]广元市中心医院骨科,四川省广元市628000

出　　处：《实用老年医学》2016年第1期54-57,共4页Practical Geriatrics

摘　　要：目的对比人工全髋关节置换术(THA)与内固定治疗老年不稳定性股骨转子间骨折的临床疗效。方法选择120例不稳定性股骨转子间骨折患者,按照手术方法不同随机分为4组,其中A组患者行THA术,B组患者行股骨近端抗旋转髓内钉(PFNA)治疗,C组患者行动力髋螺钉内固定(DHS)治疗,D组患者行Gamma钉内固定治疗,记录4组手术时间、术中出血量、下床活动时间及平均住院时间;比较患者术后髋关节功能评分及并发症的发生情况。结果 A组和B组手术时间较C组和D组显著减少且差异具有统计学意义(P<0.05);B组术中出血量显著少于其他3组(P<0.05);A组下床活动时间和平均住院时间显著少于其他3组(P<0.05);A组患者术后3月、6月、12月和18月时Harris评分均较同时间点其他3组显著增加,差异具有统计学意义(P<0.05);B组患者术后各时间点Harris评分均较C组和D组显著增加且差异均具有统计学意义(P<0.05);A组患者术后并发症少且症状较轻微。结论 THA治疗老年不稳定性股骨转子间骨折较内固定手术效果更优,患者术后关节功能恢复更好,且并发症少,具有较好的临床应用和推广价值。Objective To explore the effects of total hip arthroplasty（ THA） and internal fixation for elderly patients with unstable intertrochanteric fractures. Methods 120 cases of unstable intertrochanteric fractures were randomly divided into four groups according to different operation methods,group A treated with THA surgery,group B treated with proximal femoral nail anti-rotation（ PFNA）,group C treated with dynamic hip screw fixation（ DHS）,group D treated with Gamma screw fixation. Operation time,bleeding amount in operation,ambulation time and the average hospitalization time of four groups were recorded and compared; The postoperative hip function score and complications were compared between four groups. Results The operation time of group A and group B were significantly decreased compared with group C and group D（ P 〈0. 05）; The amount of bleeding of group B was significantly less than that of the other three groups（ P 〈0. 05）. The ambulation time and average hospitalization time of group A were significantly less than those of the other three groups（ P 〈0. 05）. Harris scores 3 months,6 months,12 months and 18 months after operation of group A were significantly increased than those of the other three groups（ P 0. 05）. Harris score of group B was significantly better than that of group C and group D（ P 0. 05）. Complications of group A were few and mild.Conclusions Treatment of THA for senile unstable intertrochanteric fracture is more effective than fixation surgery. It can improve joint function recovery with few complications.

关 键 词：全髋关节置换术 内固定 不稳定性股骨转子间骨折 老年人 

分 类 号：R683.42[医药卫生—骨科学]