PCCP与人工股骨头置换治疗高龄股骨粗隆间骨折

Percutaneous Compression Plate Internal Fixation Compared with Artificial Femoral Head Replacement for Intertrochanteric Fractures of Femur in Aged Patients-A Retrospective Study

目的探讨经皮加压钢板内固定系统(PCCP)和人工股骨头置换术治疗高龄股骨粗隆间骨折的疗效。方法自2007年1月～2009年3月,选取采用PCCP(13例)和人工股骨头置换(25例)治疗高龄股骨粗隆间骨折38例。对手术时间、出血量、下地时间、住院时间和髋关节功能进行评价。结果 38例随访12～33个月,平均17.6个月。髋关节功能按Harris评分:PCCP组13例,优良率92.3%(优7例,良5例,可1例)。人工股骨头置换组25例,优良率92.0%(优15例,良8例,可2例)。PCCP组在出血量、软组织损伤,患者输血比例上优于人工股骨头置换组(P<0.05);而人工股骨头置换组在下地时间方面优于PCCP组(P<0.05),两组在手术及住院时间,髋关节功能恢复上无明显区别。结论 PCCP和人工股骨头置换术是治疗高龄股骨粗隆间骨折的有效方法,均需严格掌握病例选择标准、手术适应证和术中操作技巧。

Objective To compare the PCCP with artificial femoral head replacement for intertrochanleric flracture of fcmur in the aged patients.Methods Firm Jan. 2007 to Mar. 2009, a total of 38 patients with AO type 31A1-A3 intertrochanteric firacture of femur were included. The operation duration, blood loss, wound healing, ambulation time,hospitalization time and fi＇acture outcome were measured. In total, 13 PCCP and 25 artificial femoral head replacement were implanted.Results The average follow-up time was 17.6 month. The rate of good functional restoration was 92.3% （excellent in 7 cases, good in 5 cases, fair in 1 case） in 13 PCCP patients, and 92.0% （excelltcnt in 15 cases, good in 8 cases, fair in 2 cases） in 25 artificial femoral head replacement patients. Blood transfusions were given in 23 femoral head replacement patients compared with 4 PCCP patients. There were no differences in operation duration, hospitalization time and fiacture outcome between the two implants. The PCCP seemed inferior to the replacement patients in rnlatiorl t0 ambulation training, but with significant advantages f0r blood loss and soft tissue healing.Conclusion PCCP and artificial femoral head replacement are effective,but indications and techniques of the operation must be paid attention to.