人工股骨头置换与内固定治疗不稳定型高龄股骨粗隆间骨折疗效对比研究

Treatment of Senile Patients with Unstable Femoral Intertrochanteric Fracture:Comparison between Hemiprosthesis Arthoplasty and Internal Fixation

目的比较分析人工股骨头置换和内固定术治疗伴有严重骨质疏松的不稳定型高龄股骨粗隆间骨折的疗效及术后并发症发生率。方法将158例高龄不稳定型股骨粗隆间骨折随机分为两组,A组78例:用股骨粗隆间骨折专用假体,行人工关节置换治疗;B组80例:行内固定治疗。结果随访68例,随访时间15～52个月。两组的合并症、手术时间、住院时间和失血量无显著差异(P>0.05);而住院时并发症发生率、扶拐下地活动时间、功能评价差异有显著意义(P<0.05)。结论对高龄股骨粗隆间骨折伴严重骨质疏松的患者进行人工关节置换,可以避免内固定失效引起的并发症,减少卧床时间,使患者较快恢复到或者接近伤前生活水平,提高生活质量,在技术成熟的情况下是合适的选择。

Objective To compare the results and complications between arthroplasty and internal fixation in the treatment of unstable femoral intertrochanteric fractures for senile patients with osteoporosis. Methods From January 2003 to December 2006, 158 senile patients with femoral intertrochanteric fractures were treated randomly with special hip prosthesis or internal fixation. Results Sixtyeight patients were followed with the periods ranging from 15 to 52 months. There were no significant difference between the two groups （P 〉0.05）, in the coexisting diseases, blood loss, duration of hospitalization and operation. There was significant difference in complications, ambulation time and function （P 〈 0. 05）. Conclusion The hemiarthroplasty is feasible and effective in treatment of the senile patients with severe osteoporosis comminuted femoral intertrochanteric fracture, which can decrease mortality, improve life quality and relieve the burden of nursing.