人工髋关节置换术与动力髋螺钉内固定治疗老年股骨转子间不稳定型骨折的临床对比  

Clinical Comparison of Artificial Hip Replacement and Dynamic Hip Screw Internal Fixation in the Treatment of Unstable Intertrochanteric Fractures in Elderly

作　　者：杨小伟[1] 周勇[1] 袁峰 辛锋[1] 丁允知 YANG Xiaowei;ZHOU Yong;YUAN Feng(Xuzhou Tumor Hospital,Xuzhou 221005,China)

机构地区：[1]江苏省徐州市肿瘤医院,江苏徐州221005 [2]徐州医科大学附属医院

出　　处：《中国医学创新》2018年第30期134-137,共4页Medical Innovation of China

基　　金：江苏省卫生厅"科教兴卫工程"临床医学中心重点学科基金资助(KF200954)

摘　　要：目的:对比研究人工髋关节置换术与动力髋螺钉内固定治疗老年股骨转子间不稳定型骨折的差异。方法:收集本院168例股骨转子间不稳定型骨折患者的资料,根据手术方式的不同将患者分为动力髋螺钉内固定组(DHS)83例与人工髋关节置换术组85例。从围术期相关指标、Harris评分、疗效优良率、术后并发症等方面比较两种术式的差异。结果:(1)与动力髋组相比,置换组患者的住院时间、手术时间、术后卧床时间明显较短,切口长度明显较短,术中出血量更少(P<0.05)。(2)60～70岁、71～80岁、81～90岁三个年龄段组,置换组的疗效优良率均显著高于动力髋组(P<0.05)。(3)在术后1、3、6个月,置换组的Harris评分均明显高于动力髋组,差异均有统计学意义(P<0.05)。(4)术后,动力髋组的并发症发生率为16.9%(14/83),主要包括术后感染4例,髋内翻5例,下肢静脉血栓3例,肢体缩短2例;置换组发生率为5.9%(5/85),包括术后感染3例,髋内翻2例。置换组并发症发生率显著低于动力髋组,差异有统计学意义(P<0.05)。结论:对老年股骨转子间不稳定型骨折患者而言,人工髋关节置换术更具优势。在不同年龄段老年患者中,置换术有着更高的疗效优良率。Objective:To compare the difference between artificial hip replacement and dynamic hip screw internal fixation in the treatment of unstable intertrochanteric fractures in elderly.Method:The data of 168 patients were collected.According to the different surgical methods,the patients were divided into 83 cases(dynamic hip group)and 85 cases of artificial hip replacement(replacement group).The differences of two operative methods were compared from perioperative related indicators,Harris score,excellent and good rate of treatment and postoperative complications.Result:(1)Compared with the dynamic hip group,the time of hospitalization,the time of operation,the bed time after the operation were shorter,the length of the incision was shorter and the amount of bleeding was less(P<0.05).(2)60-70 years group,71-80 years old group and 81-90 years old group three age groups.The excellent and good rate of the replacement group was significantly higher than that of the dynamic hip group(P<0.05).(3)At 1,3 and 6 months after operation,the Harris score in the replacement group were significantly higher than those in the dynamic hip group(P<0.05).(4)After operation,the incidence of complications in the dynamic hip group was 16.9%(14/83),including 4 cases of postoperative infection,5 cases of hip varus,3 cases of venous thrombosis in the lower extremities,2 cases of limb shortening,and the replacement group was 5.9%(5/85),including 3 cases of postoperative infection and 2 cases of hip varus.The incidence of complications in the replacement group was significantly lower than that in the dynamic hip group(P<0.05).Conclusion:For elderly patients with unstable intertrochanteric fractures,hip arthroplasty has more advantages.In elderly patients of different ages,replacement has higher efficacy and good rate.

关 键 词：股骨转子间骨折 人工髋关节置换术 动力髋螺钉 

分 类 号：R687[医药卫生—骨科学]