重建股骨距人工股骨头置换术治疗高龄股骨粗隆间骨折

Treatment of Artificial Femoral Head Replacement with Rebuild Calear Femorale for Unstable Intertrochanteric Fractures in Elderly

目的:探讨重建股骨距的人工股骨头置换术与解剖锁定钢板内固定术治疗高龄不稳定性股骨粗隆间骨折的疗效。方法:分析2004年1月-2010年11月收治的123例高龄不稳定粗隆间骨折患者。其中采用重建股骨距,使用骨水泥型人工股骨头置换术治疗61例(修复组),采取切开复位,解剖锁定钢板内固定术治疗62例(对照组)。比较2种治疗方法在手术时间长短、术中出血量、术后关节功能评分、并发症及术后下床负重时间等指标。结果:2组患者均顺利完成手术,修复组术中出血量、术后并发症发生率、开始下床负重时间与对照组比较,差异均有统计学意义(P<0.05)。术后Harris关节功能评分修复组优良率为95.08%,对照组优良率为75.81%,差异有统计学意义(P<0.05)。结论:重建股骨距的人工股骨置换术治疗高龄股骨粗隆间骨折较解剖锁定钢板内固定术更具优势,术中出血量少,术后可更早下床活动,并发症发生率更低。

Objective：To investigate the clinical effects of the artificial femoral head replacement with rebuild calcar femorale and locking compression plate （LCP） for treating unstable intertrochanteric fractures in elderly. Methods： All 123 cases of elderly patients with unstable intertrochanteric fractures were analyzed from January 2004 to November 2010. Sixty-one patients （repair group） were treated by the artificial femoral head replacement with rebuild calcar femorale. And 62 cases （control group） were treated by the LCP. The surgery time, blood loss, postoperative joint function score, postoperative complication rates, and the load time out of bed were compared between two groups. Results：The patients of two groups were all successfully operated. The two groups had same operative time. The blood loss of the repair group was less than the control group （P〈0.05）. There was significant difference in the rate of postoperative complications, load time out of bed, and the excellent rate of Harris score between the two groups （3.28%, 2. 12 ± 1.06 weeks, 95.08% in the repair group and 14.52%, 11.21 ± 1.83 weeks, 75.81% in the control group respectively, P〈0.05）. Conclusion：Artificial fem- oral head replacement with rebuild calear femorale is more superiority than LCP fixation for its advantages of less blood loss, less postoperative complications rate, and less load time.