股骨头置换与DHS内固定术治疗老年人股骨粗隆间粉碎性骨折的前瞻性对比研究

Prospective Study of Artificial Femoral Head Replacement and DHS Internal Fixation for Comminuted Femoral Intertrochanteric Fractures in Elderly Patients

目的前瞻性研究比较人工股骨头置换术与DHS内固定治疗老年股骨粗隆间粉碎性骨折的预后,评价加长骨水泥型股骨柄股骨头置换治疗股骨粗隆间粉碎性骨折的效果。方法自2001年12月～2007年12月,共收治老年股骨粗隆间粉碎性骨折109例,男59例,女50例,年龄70～94岁,平均80.7岁。随机选择股骨头置换或DHS内固定,人工股骨头置换术48例（置换组）,DHS内固定61例（内固定组）。骨折类型按Evens分型：Ⅲ型54例,Ⅳ型45例,Ⅴ型10例。随访时比较两组治疗方法的住院天数、术中X线暴露次数、手术时间、出血量、术后卧床时间、并发症发生率、髋关节功能、日常生活能力和Barthel生活质量指数。结果本组87例得到随访,时间3个月～5年,平均15.7个月,内固定失效后有2例行人工股骨头置换术治疗。内固定组在术中出血量方面有优势外,置换组在住院天数、术中X线暴露次数、术后卧床时间、并发症发生率、髋关节功能、Barthel生活质量指数等方面与内固定组比较有显著优势（P〈0.05）。结论人工股骨头置换术疗效较好,生活质量较高,可以成为治疗老年股骨粗隆间粉碎性骨折的主要方法。

Objective To compare and evaluate the artificial femoral head replacement and DHS internal fixation for the treatment of comminuted femoral intertrochanteric fractures in patients aged from 70 to 94 years old. Methods The 109 patients with femoral in- tertrochanteric fracture were treated from December 2001 to December 2007. According to Evans-Jensen classification, there were 54 patients with type Ⅲ, 45 type Ⅳ, and 10 type Ⅴ. The average age was 80.7 years old （ranged 70-94 years old）,59 of 109 were male and 50 were female. The patients were treated randomly with artificial femoral head replacement （the group Ⅰ, 48 patients） or DHS internal fixation （the group Ⅱ ,61 patients）. Main outcome measurements included days of staying at hospital, fluoroscopy exposures, the operative time, blood Loss, intraoperative complications, functional outcome （Harris hip score）, activity of daily living and barthel quality of life scores. Results Eighty-seven patients were followed up for 3 month to 60 months （average 15.7 months）. The complications rates for the group Ⅱ and the group Ⅰ were 14.75% and 6.25% respectively. Besides there were less blood loss in the group Ⅱ, there were significant differences in days of staying at hospital, fluoroscopy exposures, the operative time, intraoperative complications, functional outcome （harris hip score）, activity of daily living,and barthel quality of life scores between the two groups （P〈0.05）. The group Ⅰ had advantages. Conclusion The complication rate of artificial femoral head replacement for the treatment of comminuted intertrochanteric fractures in the elderly is low and the method has good advantages in the quality.The artificial femoral head replacement is recommended to be the treatment method of choice for comminuted femoral intertrochanteric fractures in elderly patients.