高龄老年不稳定型股骨转子间骨折DHS固定与股骨头置换的临床评估

Clinical Assessment for DHS Fixation and Hemiarthroplasty for Unstable Intertrochanteric Hip Fractures in Aged Patients

目的比较DHS内固定与股骨头置换术在治疗高龄老年不稳定型股骨转子间骨折的5项临床指标,评估两种治疗方法的优劣。方法随机抽取2000年6月～2004年12月高龄老年不稳定型股骨转子间骨折行DHS内固定(A组)与股骨头置换术(B组)各20例,对手术时间、术中出血量、术后下床锻炼时间、并发症、疗效优良率5项临床指标进行比较。结果5项临床指标显示B组疗效明显优于A组,两组数据经统计学处理有显著性差异(P<0.01)。结论股骨头置换术的疗效明显优于DHS内固定,其可作为临床治疗高龄老年不稳定型股骨转子间骨折的一种合理的选择。

Objective To assess the merits and defects of DHS internal fixation and hemiarthroplasty in treatment of unstable intertrochanteric hip fractures in aged patients by comparing five clinical factors, and to guide the clinical treatment. Methods From June 2000 to December 2004, 40 aged patients with unstable intertrochanteric hip fractures were followed up at random. DHS internal fixation （group A, in 20 patients） and hemiarthroplasty （group B, in 20 patients） were included. The data in each group were collected for statistical analysis on the following aspects： the operative time, the blood loss, the time of initiation of exercise after operation, complications, and the excellent and good rate. Results The operative time was （118 ± 18） minutes in group A, and （88 ± 15） minutes in group B. The blood loss was （610 ± 256） ml in group A, and （405 ± 186） ml in group B. The time of initiation of exercise after operation was （68 ± 2.8） days in group A, and （18 ± 6.3） days in group B. The complications occurred in 12 patients in group A, and 4 patients in group B. The excellent and good rate was achieved in 12 patients in group A, and 18 patients in group B. There was significant difference between group A and group B （ P 〈 0.01 ）. Conclusion The hemiarthroplasty is better than DHS internal fixation in treatment of unstable intertroehanteric hip fractures in aged patients with the advantages, such as the shorter operation time, the shorter time of exercise after operation, less complications and quicker recovery. It can be a rational option for treatment of unstable intertroehanteric hip fractures in aged patients.