内固定与关节置换术治疗高龄股骨转子间骨折的围手术期疗效比较

Comparison of perioperative efficacy between internal fixation and hemiarthroplasty for intertrochanteric fractures in elderly patients

目的 比较内固定与关节置换术治疗高龄股骨转子间骨折的围手术期疗效.方法 回顾性分析2004年5月至2010年10月间258例采用内固定或关节置换术治疗的高龄股骨转子间骨折病例资料,根据术前病情评估将所有病例分为一般情况较好者（A组,177例）和一般情况较差者（B组,81例）两组.分析手术时间、术中出血量、输血量、术后开始下地活动时间、术后2周内的并发症情况,并在两组组内分别比较不同术式的疗效.结果 A组患者不同术式间术后并发症的发生情况和病死率相似.B组患者采用关节置换术的术后并发症的发生情况和病死率均高于内固定术.结论 内固定与关节置换术治疗高龄股骨转子间骨折的围手术期疗效在一般情况较好的患者中相似,而在一般情况较差的患者中内固定较好.

Objective To compare the perioperative efficacy between PFN internal fixation and hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients. Methods Clinical data of 258 patients with intertrochanteric fractures cases admitted from May 2004 to October 2010 were retrospectively reviewed. According to the health condition of patients, 177 cases were in good health （group A） and 81case were in poor health （group B）. Patients in both group were treated with internal fixation or hemiarthroplasty. The Operation time, the volume of blood loss and blood transfusion, postoperative complications in both group were reviewed and compared between two therapeutic modalities. Results There were no difference in complications between two modalities in group A; but the complication rate of hemiarthroplasty was higher than that of PFN internal fixation in group B. Conclusion The perioperative results of PFN fixation are the same as hemiarthroplasty in treatment of intertrochanteric fractures for elderly patients with good health conditions, but are better than those of hemiarthroplasty for patients with poor health conditions.