髓内、外内固定与人工关节置换术治疗高龄股骨粗隆间骨折疗效对比研究  

A comparative study of clinical results of intramedullary fixation,extramedullary fixation and arthroplasty in treatment of the elderly patients with intertrochanteric fracture

作　　者：李兴艳[1] 张津明 鲍远[1] 叶亚平[1] 胡伟华[1] 印卫锋[1] 郭风劲[1] 陈安民[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院关节中心1区,湖北武汉430030

出　　处：《中国骨与关节损伤杂志》2016年第10期1030-1033,共4页Chinese Journal of Bone and Joint Injury

基　　金：国家自然基金课题(2012AA02A612)

摘　　要：目的 比较髓内、外内固定与人工关节置换术治疗高龄股骨粗隆间骨折的临床疗效。方法 回顾分析自2012-09—2015-01诊治的107例高龄粗隆间骨折的临床资料,根据手术方式不同分为髓内固定（PFNA组）、髓外固定（PFLCP组）和人工关节置换（BHR组）,比较3组出血量、时间和并发症发生率、切口大小、术中透视次数、术后患肢完全负重时间、卧床和住院时间、术后髋关节Harris评分。结果 3组均顺利完成手术。所有患者均获随访3-36个月,平均12个月。BHR组与另外2组比较,手术时间短、切口大、出血多、透视少、卧床和住院时间短、术后负重时间早、髋关节功能更好,差异有统计学意义（P〈0.05）,3组并发症发生率比较差异无统计学意义（P〉0.05）。术后9个月3组均获得良好的关节功能,Harris评分两两比较差异无统计学意义（P〉0.05）。结论 双极人工股骨头置换术治疗高龄股骨粗隆间骨折术后可获得良好的关节功能,患肢完全负重早,是一种安全的治疗方法。Objective To compare the clinical results of intramedullary fixation, extramedullary fixation and arthroplasty in treatment of the elderly patients with intertrochanteric fracture. Methods The clinical results and follow-up data were retrospective analyzed in the elderly patients with intertrochanteric fracture which were treated in our hospital from Sep. 2012 to Jan. 2015. The patients were divided into 3 groups according to surgical options as group of intramedullary fixation（PFNA）, group of extramedullary fixation（PF-LCP） and group of arthroplasty（BHR）. The amount of bleeding during operation, operation time, rate of post-operative complications, length of incisions, times of intraoperative fluoroscopy, time of weight loading after operation, bed rest time, duration of hospital stays and Harris hip score were compared and analyzed after operation. Results All patients were followed-up for 3-36 months, with an average of 12 months. All 3 groups underwent operation successfully. Compared with the other two groups, group BHR had shorter operation time, longer length of incisions, more amount of bleeding during operation, less times of intraoperative fluoroscopy, shorter time of bed rest and hospital stays, earlier weight loading after operation and better hip joint functions after operation （P 〈0.05）, while there was no significant difference among three groups on the rate of post-operative complications （P 〉0.05）. All cases had good hip joint function at 9 months postoperatively, there was no statistically significant difference in Harris hip score between any two of the three groups （P 〉 0.05）. Conclusion Bipolar hemi-arthroplasty is a safe and effective treatment in the elderly patients with intertrochanteric fracture which has earlier weight loading and good hip joint functions after operation.

关 键 词：股骨粗隆间骨折 人工关节置换 髓内固定 髓外固定 高龄 

分 类 号：R687.3[医药卫生—骨科学]