人工股骨头置换与内固定治疗老年股骨转子间骨折疗效比较

Clinical review and comparison of cemented hemiprosthesis arthroplasty and internal fixation for treatment of intertrochanteric fracture in the elderly

目的比较分析骨水泥人工股骨头置换术和骨折内固定术治疗老年股骨转子间骨折的疗效及术后并发症发生率。方法将135例≥75岁股骨转子间骨折患者随机分为2组，A组：骨水泥半髋关节置换术组；B组：内固定术组。结果随访1一8年，平均3．5年。两组的合并症、住院时间和骨折类型差异无显著性（P〉0．05）；而并发症的发生率（A组11．8％，B组27．5％）、扶双拐下地活动时间（A组3—21d，B组90d）、手术时间（A组45—70min，B组89—137min）及功能评价（A组优良率86．3％，差3．9％；B组优良率69．6％，差15．9％）差异有显著性（P〈0．05，P〈0．01）。结论采用人工股骨头置换术治疗高龄患者股骨转子间骨折。操作相对简单、创伤小，避免了骨折不愈合及内固定失效等问题，并发症发生率与病死率低，可明显提高患者的生活质量。

Objective To compare the results and complications of cemented hemiprosthesis arthroplasty （CHA） and internal fixation （IF） in the treatment of intertrochanteric fracture in aged patients. Methods One hundred and thirty-five patients with intertrochanteric and subtrochanteric fracture aged over 75 years underwent either CHA （ Group A） or IF （ Group B） randomly were reviewed. Results The follow-up period ranged from 1 to 8 years （ mean 3.5 years）. In comparison of the coexisting diseases, duration of the hospitalization and the interval from injury to surgery, fracture classification, there were no significant difference between the two groups（P 〉0. 05 ）. While in comparison of the complications （ 11.8 % in Group A, 27. 5% in Group B）, ambulation time（3 -21 d in Group A, 90 d in Group B）, the duration of the operation（4-70 rain in Gruop A,89 - 137 min in Group B）and function（86. 3% of good rate and 3.9% of poor in Group A compared with 69. 6% of good and 15.9% of poor in Group B）, there was a significant difference（P 〈0.05,P〈0.01）. Conclusions It＇s an effective method to treat the intertrochanteric fracture in aged patients with cemented hemiprosthesis arthroplasty. The result is satisfactory. It can avoid the nonunion and internal fixation failure, decrease the complications, reduce the mortality, and improve the life quality in the aged patients.