内固定物与人工半髋关节置换治疗高龄不稳定股骨粗隆间骨折的疗效分析

Comparison of hemiarthroplasty and fixation for the treatment of unstable intertrochanteric hip fractures in senile patients

[目的]分析比较内固定物与人工半髋关节置换治疗高龄不稳定型股骨粗隆间骨折的疗效。[方法]回顾性分析2008年7月～2010年7月间治疗的高龄不稳定型股骨粗隆间骨折71例。其中内固定组36例,半髋关节置换组35例。比较2治疗组在手术时间、术中出血量、手术输血量、术后卧床时间、内科并发症、内置物并发症、术后1年关节功能状况等方面的情况。[结果]内固定组和人工半髋关节置换组的平均随访时间分别为18、20个月。内固定治疗组与半髋关节置换组相比较,手术时间及术后卧床时间均较长,内科并发症、内置物并发症较多,髋关节功能恢复稍差(P<0.05)。但手术时间、术中出血及手术输血量无明显差别(P>0.05)。[结论]人工半髋关节置换术治疗高龄不稳定型股骨粗隆间骨折,负重活动早、并发症发生率低、功能恢复满意,可明显提高患者的生活质量。

[ Objective] To compare the effects of fixation and hemiarthroplasty in intertrochanteric hip fractures in elderly patients. [ Method] Totally 71 intertrochanteric hip fractures in elderly patients with complete clinical data were retrospectively analyzed, who were treated with hemiarthroplasty or fixation from July 2008 to July 2010. Thirtysix were treated with PFN fixa tion,35 were treated with hemiarthroplasty. Comparison was made between the two treated groups in terms of operative time, the blood lost, blood transfusion during or after surgery, time for bed rest postoperatively, postoperative complications and St. Michael hip score one year after surgery. [ Result] The average duration of followup for fixation and hemiarthroplasty were 18 and 20 months respectively. Compared with the group of hemiarthroplasty, the group of internal fixation experienced longer time for bed rest postoperatively, worse hip function, higher rate in the postoperative internal medicine complications and the postoperative implant complications, and the differences between two groups had statistical significance （ P 〈 0.05 ）. But the differences in op erative time, blood lost, blood transfusion during or after surgery, had no statistical significance （ P 〉 0.05 ）. [ Conclusion ] It is an effective method to treat the intertrochanteric hip fractures in elderly patients with hemiarthroplasty with satisfactory results. It can allow early full weight bearing after surgery, decrease the complications, and improve the life quality in the elderly pa tients.