股骨距替代髋关节置换与髓内钉治疗高龄股骨转子间骨折疗效分析  

Comparison of calcar replacement arthroplasty and Intertan nail in treatment of intertrochanteric fracture in the aged

作　　者：卢晓栋[1] 王奔[1] 徐炜[1] 张庆[1] 韩栋[1] 赵永涛[1] 

机构地区：[1]天津市职业病防治院工人医院骨科,300171

出　　处：《中华医学杂志》2016年第31期2466-2471,共6页National Medical Journal of China

摘　　要：目的比较股骨距替代型髋关节置换与髓内钉治疗高龄股骨转子间骨折的临床疗效。方法回顾性分析2008年1月至2013年7月天津市职业病防治医院骨科收治的58例高龄股骨转子间骨折患者，根据手术方式不同分为股骨距替代型髋关节置换和InterTan髓内钉组两组；其中股骨距替代型髋关节置换29例，男8例，女21例，年龄（85．3±4．9）岁，骨折AO分型：A1型8例，A2型16例，A3型5例；InterTan髓内钉组29例，男10例，女19例，年龄（86．1±5．6）岁，骨折AO分型：A1型11例，A2型15例，A3型3例。观察并比较两组患者之间的手术时间、术失出血量、住院时间、术后开始下地时间、并发症发生率、病死率、髋关节HaMs评分、生存质量SF-36评分及日常生活能力评分（ADL）情况。结果股骨距替代型髋关节置换组和InterTan髓内钉组分别有27例和26例患者随访至术后24个月。两组患者住院时间、并发症发生率、死亡率、Harris评分、ADL评分与SF-36评分差异无统计学意义（P〉0．05）。髋关节置换组与InterTan髓内钉组手术时间分别为（78±29）min和（59±32）min，术中失血量分别为（316±185）ml和（108±97）ml，髋关节置换组下地活动的时间分别为（15．0±5．8）d和（32．0±12．7）d，两组间差异有统计学意义（P〈0．05）。结论股骨距替代型髋关节置换与InterTan髓内钉手术在短期随访中发症发生率、病死率、髋关节功能和患者生活质量相近。与InterTan髓内钉相比，股骨距替代型髋关节置换治疗高龄股骨转子间骨折，手术时间更长，术中出血量更多，但患者下地活动时间更早。Objective To compare the clinical efficacy between calcar replacement arthroplasty and InterTan nail in treatment of intertrochanteric fractures in the aged. Methods From January 2008 to July 2013,a total of 58 elderly patients with intertrochanterie fracture , had been treated in Department of Orthopaedics, Tianjin Occupational Diseases Control and Treatment Hospital, were retrospectively compared. Half of them were treated with calcar replacement arthroplasty and half with InterTan nails. In the calcar replacement arthroplasty group, there were 8 men and 21 women, with an average age of （85.3± 4. 9） years, there were 8 AI ,16 A2 and 5 A3 fractures according to the AO classification. In the InterTan nail group, there were 10 men and 19 women, with an average age of （86. 1±5.6） years, there were 11 A1,15 A2 and 3 A3 fractures according to the AO classification. The 2 groups were compared in terms of the duration of the operation, intraoperative blood loss, hospitalization time, time of off-bed activity, complications, mortality rate, Harris hip score, short form 36 questionnaire score and ADL score. Results Twenty-seven patients in the calcar replacement arthroplasty group and twenty-six patients in the patients in each group were followed up InterTan nail group were follow-up for a period of 24 months. There were no significant differences between the 2 groups regarding hospitalization time, complications, mortality rate, Harris hip score, short form 36 questionnaire score and ADL score（ P 〉 0. 05）. However,the operative time, intraoperative blood loss, and the time of off-bed activity for the calcar replacement arthroplasty and InterTan nail groups was respectively （78±29） minutes vs （59 ±32） minutes, （316 ± 185） ml vs （108 ±97） nd,and （ 15 ±5.8 ） days vs （ 32 ±12. 7 ） days, all of them with a significant difference （ P 〈 0. 05 ）. Conclusion The patients in the calcar replacement arthroplasty group suffered longer operative time and more blood loss, but they c

关 键 词：骨折固定术 髓内 关节成形术 置换 髋 髋骨折 老年人 

分 类 号：R687.3[医药卫生—骨科学]