动力髋螺钉和人工股骨头置换治疗高龄股骨粗隆间骨折

Dynamic Hip Screw and Replacement of Artificial Femoral Head for Senile Intertrochanteric Femoral Fracture

目的探讨动力髋螺钉(DHS)和人工股骨头置换治疗高龄股骨粗隆间骨折的疗效。方法2004年3月-2007年8月,采用DHS和人工股骨头置换治疗高龄股骨粗隆间粉碎性骨折56例。根据Evans分型,Ⅱ型13例,Ⅲ型25例,Ⅳ型16例,Ⅴ型2例。骨质疏松Singh指数分级(股骨颈小梁指数法):Ⅱ级4例,Ⅲ级36例,Ⅳ级16例。对手术时间、出血量、住院时间和髋关节功能进行评价。结果56例术后随访12～39个月,平均18.6个月。髋关节功能按Har-ris评分:DHS组33例,优良率84.8%(优11例,良17例,可4例,差1例)。人工股骨头置换组23例,优良率95.7%(优13例,良9例,可1例)。人工股骨头置换组在手术时间、出血量和髋关节优良率方面均显著优于DHS内固定组。结论DHS和人工股骨头置换是治疗高龄股骨粗隆间粉碎性骨折的有效方法,均须严格掌握病例选择标准、手术适应证和术中操作技巧。

Objective To discuss the clinical effect of dynamic hip screw（DHS） and replacement of artificial femoral head for intertrochanteric femoral fracture in aged patients. Methods From March 2004 to August 2007,56 cases with intertrochanteric femoral fractures were treated by DHS and replacement of artificial femoral head. According to Evans classification, there were 13 cases with type Ⅱ ,25 cases with type Ⅲ ,16 with type Ⅳ and 2 cases with type V fracture. Osteoporosis was graded by Singh-index, and there were 4 cases with level Ⅱ,36 with level Ⅲ and 16 with level Ⅳ. The operation time, amount of bleeding, hospitalization time and postoperative function of hip were evaluated. Results The follow-up of 12 to 39 months （ average 18.6 month） showed that 28 cases among 33 cases（84.8% ） treated by DHS and 22 cases among 23 cases（95.7% ） treated by artificial femoral head replacement had good functional restoration. Artificial femoral head replacement group had better effect than DHS group on operation time, amount of bleeding, hip function （P 〈 0.05 ）. Conclusion Both femoral head prosthesis replacement and DHS are effective for senile intertrochanteric comminuted fracture, but the suitable cases, indications, and operative techniques must be paid more attention.