半髋置换与股骨近端防旋髓内钉治疗股骨粗隆间骨折的比较  

Cemented bipolar hemiarthroplasty versus internal fixation with proximal femoral nails anti-rotation for treatment of unstable intertrochanteric fractures in the elderly

作　　者：冯暘 陈斌[2] 张焱[2] 骆宇春[2] 王诗波[2] 

机构地区：[1]江苏大学临床医学院,江苏镇江212013 [2]解放军第101医院,江苏无锡214044

出　　处：《中国矫形外科杂志》2017年第12期1081-1085,共5页Orthopedic Journal of China

摘　　要：[目的]比较骨水泥型半髋关节置换与股骨近端防旋髓内钉内固定治疗老年不稳定股骨粗隆间骨折的临床疗效。[方法]回顾性分析2014年3月~2016年3月收治于解放军101医院骨科的老年不稳定股骨粗隆间骨折患者,选取符合本次研究病例共52例,Evans-Jensen分型所有患者均为Ⅲ型及Ⅳ型,其中骨水泥型半髋关节置换28例(置换组),股骨近端防旋髓内钉24例(固定组),采用Harris评分作为评估髋关节功能的主要依据。[结果]置换组术后恢复独立负重和恢复至伤前活动水平的平均时间分别为(9.82±0.21)d和(35.76±0.87)d,而固定组相应平均时间为(57.43±1.10)d和(74.26±1.33)d,两组间比较差异有统计学意义(P<0.05)。置换组并发症7例,固定组15例,其中褥疮、肺炎、伤口感染、尿路感染、深静脉血栓形成发生率组间比较差异均无统计学意义,但术后并发症总发生率置换组少于固定组,差异有统计学意义(P<0.05)。术后平均随访18个月,3个月时Harris评分置换组为(77.82±1.18)分,固定组为(66.62±2.52)分;12个月时为(80.46±1.66)分和(68.83±1.42)分,24个月时为(85.89±1.76)分和(72.86±1.24)分,置换组较固定组评分更高,差异有统计学意义(P<0.05)。[结论]相比于股骨近端防旋髓内钉固定,骨水泥型半髋关节置换治疗不稳定股骨粗隆间骨折疗效可靠,术后并发症少。[Objective] To compare the clinical outcomes of cemented bipolar hemiarthroplasty versus proximal femoral nailing anti-rotation for unstable intertroehanteric fractures in the elderly. [Method] From March 2014 to March 2016, 52 elderly patients who suffered from Evans type Ill and IV unstable intertrochanteric fractures were include into this study. Of them, 28 patients underwent cemented bipolar hemiarthroplasty, the replacement group, while the remaining 24 patients re- ceived internal fixation of the fracture with proximal femoral nailing anti-rotation, the fixation group. The times elapsed forfunctional recovery, postoperative complication incidence and Harris hip scores were used to assess the clinical out- comes. [Results] The time to recover full weight bearing and the time to return to pre-fracture daily activity levels were （9.82±0.21） days and （35.76±0.87） days in there-placement group, whereas （57.43±1.10） days and （74.26± 1.33） days in the fixation group respectively, associated with statistically significant differences in the eorresponding time between the two groups （P〈0.05） . Postoperative complications were noted in 7 patients of the replacement group, while 15 patients of the fixation group, there was significant difference in the gross complication incidence between them （P〈0.05） . Additionally, compared the replacement group with the fixation group, the Harris scores were recorded as （77.82±1.18） versus （66.62±2.52） at 3 months, 80.46±1.66 versus 68.83±1.42 at 12 months, as well as 85.89± 1,76 versus 72.86±1.24 at 24 months postoperatively, there were statistically significant differennc.es between the two groups in each time point （P〈0.05） . [Conclusion] Primary cemented hemiarthroplasty is effective and reli- able treatment for unstable intertroehanterie fractures in the elderly, with less postoperative complications compared to internal fixation.

关 键 词：不稳定股骨粗隆骨折 半髋关节置换 股骨近端髓内钉 

分 类 号：R687.3[医药卫生—骨科学]