动力髋螺钉和人工股骨头置换治疗高龄患者转子间骨折的应用

Treatment of Intertrochanteric Femoral Fracture with DHS and Hemi-hip Prosthesis Replacement in the Eldery

目的：观察动力髋螺钉（dynamic hip screw,DHS）和骨水泥型双极人工股骨头置换在高龄患者粉碎型股骨转子间骨折治疗中的应用。方法：对1998年1月至2005年12月本院收治的62例伴有骨质疏松的高龄粉碎型股骨转子间骨折患者进行回顾性研究,A组38例采用DHS内固定术,B组24例采用骨水泥型双极人工股骨头置换术,对两组的手术时间、术中出血量、术后下地时间、治疗效果、并发症发生率进行比较。结果：本组62例患者全部获得1-4年（平均2.5年）随访。DHS组（A组）出现螺钉松动1例,股骨头切割1例,髋内翻2例,肺部感染3例,优良率达76.3%;人工股骨头置换组（B组）出现髋部疼痛1例,无假体松动及肺部感染,优良率达83.3%。两组的手术时间、术中出血量、术后并发症及疗效优良率对比,差异无统计学意义（P〉0.05）,人工股骨头置换组较DHS组病人能较早下地活动（P〈0.01）。结论：骨水泥型双极人工股骨头置换治疗伴有骨质疏松的高龄患者粉碎型股骨转子间骨折,在近期疗效上与DHS相比,固定更牢固,能早期下床活动,方法可行有效。

Objective：To observe the clinical efficacies of DHS and hemi-hip prosthesis replacement in treatment of comminuted intertrochanteric femoral fracture in the elderly.Methods：62 patients with comminuted intertrochanteric femoral fractures and severe osteoporosis between 1998 and 2005 were retrospectively analyzed.Out of these,38 cases were fixed with DHS（group A）,and the other 24 were treated with bone cement hemi-hip prosthesis replacement（group B）.Varied factors were compared in two groups.Results：The time of follow-up was 1 to 4 years（mean time was 2.5 years）in all 62 patients.The excellent rate of DHS group was 76.3%,with one patient suffering loosened screw,one patient showing DHS cut-out from femoral head,2 cases having inverted hip and 3 being with pulmonary infections.The excellent rate of group B was 83.3%,with only 1 case reporting hip pain.There were no significant statistical differences between two groups in operation time,blood loss,complications and excellent rate（P〉0.05）.The patients in group B could exercise on the ground earlier than patients in group A（P〈0.01）.Conclusions：The short-term outcomes favored bone cement hemi-hip prothesis replacement over DHA for treatment of elder patients with intertrochanteric femoral fracture and osteoporosis in more stable fixation and earlier recovery to bedside activities.