内固定术与半髋置换治疗不稳定股骨粗隆间骨折疗效对比

Effectiveness comparison of internal fixations and hemiarthroplasty for unstable intertrochanteric fractures in senile patients

[目的]通过内固定术和半髋置换治疗老年股骨粗隆间不稳定骨折的疗效比较,探求合理的治疗方法。[方法]对不稳定股骨粗隆间骨折患者分别进行动力髋螺钉DHS内固定(A组50例)、股骨近端防旋髓内钉PFNA固定(B组42例)和半髋置换术(C组32例)治疗。记录三组手术时间、术中出血量、术后引流量、术后卧床时间、下地负重时间、并发症及髋关节功能情况。[结果]随访10～18个月(平均13.5个月),C组术后卧床时间、下地负重时间短,出血量、术后引流量多,与A、B组差异有统计学意义(P<0.05)。A、B组术后卧床时间、下地负重时间差异无统计学意义(P>0.05)。B组手术时间、出血量、术后引流量少,与A、C组比较差异有统计学意义(P<0.05)。A、B、C组并发症情况、疗效不全相同,依据Harris评分计算的优良率分别为82.0%、90.48%和90.63%,B、C组差异无统计学意义(P>0.05),A、B组及A、C组差异有统计学意义(P<0.05)。[结论]治疗老年不稳定股骨粗隆间骨折首选内固定术,PFNA疗效更优;半髋置换疗效好但不主张作为初始治疗手段。

[ Objective ] To discuss a reasonable treatment for unstable intertrochanteric fractures in senile patients by comparing the effects of DHS, PFNA fixation and hemiarthroplasty. [ Method ] Totally 124 unstable intertrochanteric fractures in senile patients were treated with DHS（ group A,50） or PFNA （group B,42） fixation or hemiarthroplasty （group C ,32）. The data of operative time, blood lost, blood drainge ,time of bed rest and full-weight bearing, complications and Harris hip funtion score were recorded for statistical analysis. [ Result] The average duration of follow up for group A, B and C was 13.5 months （10 - 18 months）. Compared with group A and B, group C experienced shorter time for bed rest and full-weight bearing, more blood lost and blood drainge, and the differences among three groups had statistical significance （ P 〈 0.05 ）. Compared with group A and C, group B experienced shorter operative time,less blood lost and blood drainge. Differences among the three groups had statistical significance （P 〈 0.05 ）. Excellent-to-fine result rate by Harris hip score of group A, B and C were 82.0% ,90.48% and 90.63 %. Difference between group A and B, group A and C had statistical significance （P 〈 0.05 ）. [ Conclusion ] For senile patients with unstable intertrochanterie fractures ,PFNA was superior to DHS. Hemiarthroplasty should not be the first choice though it has good effectiveness.