两种方法治疗高龄股骨转子间粉碎性骨折的疗效比较  

Efficacy comparison of two methods in the treatment of comminuted femoral intertrochanteric fractures in the elderly

作　　者：吴润柏 施坦 叶伟彬 WU Run-bo;SHI Tan;YE Wei-bin(SectionⅠ,Dept of Orthopaedics,the People′s Hospital of Dongguan City,Dongguan,Guangdong 523018,China)

机构地区：[1]东莞市人民医院骨一科,广东东莞523018 [2]东莞市人民医院应急办公室,广东东莞523018

出　　处：《临床骨科杂志》2022年第6期854-858,共5页Journal of Clinical Orthopaedics

摘　　要：目的比较人工股骨头置换与股骨近端防旋髓内钉固定治疗高龄股骨转子间粉碎性骨折的疗效。方法根据治疗方案不同将104例高龄股骨转子间粉碎性骨折患者分为置换组(52例,采用人工股骨头置换治疗)和内固定组(52例,采用股骨近端防旋髓内钉固定治疗)。比较两组手术情况、髋关节功能Harris评分、髋关节活动度及术后并发症发生率。结果患者均获得6个月随访。手术时间、术中出血量、切口长度内固定组短(少)于置换组(P<0.01)。术后扶拐不负重时间置换组早于内固定组(P<0.001)。末次随访时Harris评分、髋关节屈曲与外展活动度置换组均优于内固定组(P<0.001)。术后并发症发生率置换组低于内固定组(P<0.001)。结论相较于股骨近端防旋髓内钉固定,人工股骨头置换治疗高龄股骨转子间粉碎性骨折手术创伤较大,但术后扶拐不负重时间较早,并发症较少,髋关节功能及关节活动度改善效果更佳。Objective To compare the efficacy of artificial femoral head replacement and proximal femoral nail antirotation fixation for elderly femoral intertrochanteric comminuted fractures.Methods The 104 elderly patients who suffered from comminuted femoral intertrochanteric fractures were divided into two groups according to different treatment plan:replacement group(52 cases,artificial femoral head replacement)and internal fixation group(52 cases,proximal femoral nail anti-rotation fixation).The operation situation,Harris score of hip function,hip joint range of motion and incidence rate of complications were compared between the two groups.Results All patients were followed up for 6 months.The operative time,intraoperative blood loss and incision length were shorter(less)in the internal fixation group than those in the replacement group(P<0.01).The postoperative crutches without weight bearing time in the replacement group was earlier than that in the internal fixation group(P<0.001).At the last followup,Harris score,the range of motion of hip flexion and abduction in the replacement group were all better than those in the internal fixation group(P<0.001).The incidence rate of postoperative complications in the replacement group was lower than that in the internal fixation group(P<0.001).Conclusions Compared with proximal femoral nail anti-rotation fixation,artificial femoral head replacement in the treatment of elderly femoral intertrochanteric comminuted fractures has greater surgical trauma,but the postoperative crutches without weight bearing start time is earlier,complications are fewer,and the improvement effect of hip joint function and range of motion are better.

关 键 词：人工股骨头置换术 股骨转子间粉碎性骨折 髋关节功能 老年人 

分 类 号：R683.42[医药卫生—骨科学] R687.33[医药卫生—外科学]