人工股骨头置换与动力髋螺钉治疗老年股骨转子间骨折的对比研究

A comparative study on hemiarthroplasty and dynamic hip screw treating femoral intertrochanteric fractures in the old patients

目的比较人工股骨头置换与动力髋螺钉（DHS）内固定治疗老年股骨转子间骨折的临床效果。方法自2004年1月至2007年4月，将62例不稳定的老年股骨转子间骨折患者按随机数字表法分为两组进行治疗：人工股骨头置换（关节组）和DHS内固定（螺钉组）各31例，经随访分析，对比两组疗效。结果58例患者获随访（关节组28例，螺钉组30例），随访时间13～49个月，平均80岁。两组平均手术时间：关节组（76．07±6．29）min，螺钉组（117．50±8．88）min（P〈0．05）；术中平均出血量：关节组（305．36±34．26）ml，螺钉组（431．67±53．31）ml（P〈0．05）；并发症：关节组3例，螺钉组10例（P〈0．05）；髋关节功能评定（Harris评分法）：关节组（85．46±3．05）分，螺钉组（79．73±2．57）分（P〉0．05）。结论DHS内固定仍可作为治疗老年股骨转子间骨折的有效术式之一；对于高龄、骨质疏松、不稳定股骨转子间骨折患者，人工股骨头置换术中出血较少，下地时间较早，并发症较少，但不能取代内固定手术。

Objective To compare the clinical effects of hemiarthroplasty and dynamic hip screw （DHS） in treatment of unstable femoral intertrochanteric fractures in the elderly. Methods A total of 62 elderly patients with unstable femoral intertrochanteric fractures treated from January 2004 to April 2007 were randomly divided into DHS group and hemiarthroplasty group, with 31 patients in each group. The patients were followed up to compare the clinical effects between two groups. Results Of all, 58 patients （including 28 patients in the hemiarthroplasty group and 30 in DHS group） were followed up for 13-49 months. The mean operation time was （76.07 ±6.29 ） minutes in hemiarthroplasty group and （ 117.50 ±8.88 ） minutes in DHS group （ P 〈 0. 05 ）. The mean blood loss during operation was （305.36 ±34.26） ml in hemiarthroplasty group and （431.67 ±53.31 ） ml in DSH group （ P 〈 0.05 ）. The postoperative complications occurred in three patients in hemiarthroplasty group and 10 in DHS group, with statistical difference （ P 〈 0. 05 ）. The Harris score for hip function was （ 85. 46 ±3.05 ） points in hemiarthroplasty group and （ 79.73 ±2.57 ） points in DHS group, with no statistical difference between two groups （ P 〉 0.05 ）. Conclusions DSH is still one of effective methods for patients with unstable femoral intertrochanterie fractures. Hemiarthroplasty can diminish bleeding during operation, help walk earlier and reduce complications and is a better selection for the elderly patients with osteoporosis and unstable femoral intertrochanteric fractures. However, hemiarthroplasty can not replace DHS.