人工股骨头置换与DHS内固定治疗高龄股骨转子间骨折的临床比较

the comparative study of clinical curativ effect between dhs internal fixation and hemiprosthesis arthoplasty of the elderly intertrochanteric fracture

目的通过DHS内固定手术组与人工股骨头置换组治疗高龄股骨转子间骨折的临床疗效对比,对DHS内固定术与人工股骨头置换术的治疗效果进行分析。方法2003年到2008年我院收治的高龄（〉70岁）股骨粗隆间骨折患者,随机抽取[MU2]人工股骨头置换治疗组患者39例作为观察组,DHS内固定治疗组40例作为对照组。两组患者共79例,男35例,女44例;年龄71~96（78.2±5.74）岁。随访6~24（8±2）个月。骨折类型按Tronzo—Evans分型,I型13例,Ⅱ型22例,Ⅲ型23例,Ⅳ型17例,V型4例,术后按Harris评分标准进行评分。结果两组在手术时间、术中出血量、住院时间比较,差异无统计学意义（P〉0.05）。而在下地负重时间、术后并发症、术后髋关节功能恢复程度比较,差异有统计学意义（P〈0.05）。结论采用人工关节置换术治疗高龄股骨转子间骨折,术后卧床时间短,可早期下地负重,术后并发症发生率低,早期髋关节功能恢复良好,疗效优于内固定治疗方法。

Objective：By comparing the DHS internal fixation group with hemiprosthesis arthoplasty group of therapy of the elderly Comminuted intertrochanteric fracture.To analysethe treatment effect between the DHS internal fixation and hemiprosthesis arthoplasty.Methods： Among the elderly patients of intertrochanteric fracture whom were treated in our hospital between 2003 and 2008,39 cases are chosen randomly from hemiprosthesis arthoplasty group as＂observed group＂and 40 cases of DHS internal fixation group as＂control group＂.All the patients were at an average age of 78.2（ranged 71-96 years）.35 of 79 cases were male,44 of 79 cases were female.The follow-up period ranged from 6 to 24 months（mean,8.5 months）.The types of fractures were typed byTronzo-Evans,which include 35 cases of typeⅡ,24 casesof typeⅢ,20 cases of typeⅣ.All cases would be graded by Harris standards after operation.Results： By comparing two groups in operative time,bleed volume and duration of the hospitalization.There was no significant difference.（P0.05）but,comparing,the time of allow weight-bear after operation,postoperative complications,postoperative recovery of hip function,there was significant difference.（P0.05）Conclusion： Using the hemiprosthesis arthoplasty to treat the elderly comminuted intertrochanteric fracture,keep bed time is short afteroperation,allow early weight-bearing,have low incidence ofpostoperative complications,early functional recovery of hip is good,more effective than internal fixation in the treatmentmethods.