人工髋关节置换术与内固定治疗高龄不稳定性股骨转子间骨折的疗效比较

Efficacy comparison between artificial hip arthroplasty and internal fixation for elderly patients with instability fractures intertrochanteric

目的比较人工髋关节置换术与内固定治疗高龄不稳定性股骨转子间骨折的效果。方法选择2009年1月～2012年9月大庆油田总医院治疗的高龄不稳定性股骨转子间骨折患者100例,分为4组:A组22例,行人工髋关节置换术治疗;B组28例,行防旋股骨近端髓内钉(PFNA)内固定治疗;C组26例,行动力髋螺钉内固定(DHS)治疗;D组24例,行Gamma钉内固定治疗。比较4组术后3、6、12、18个月髋关节功能Harris评分的变化及并发症情况。结果 4组患者髋关节功能Harris评分均随术后时间延长而均较前一时间点明显提高,差异均有统计学意义(均P<0.05);同一时间点A组髋关节功能Harris评分明显高于其他各组,差异均有统计学意义(均P<0.05);B组的髋关节功能Harris评分在同一时间点明显高于C组和D组,差异均有统计学意义(均P<0.05);C组和D组的髋关节功能Harris评分在同一时间点比较,差异无统计学意义(P>0.05)。A组无髋内翻畸形、骨折不愈合、延迟愈合、内固定松动等并发症的发生。B组随访期内内固定松动、断裂及髋内翻畸形发生。C组出现内固定松动2例,髋内翻畸形3例。D组出现1例(Ⅱ型)钉远端股骨干骨折,1例大腿中上端疼痛;结论与内固定术相比,人工髋关节置换术更具优势,近期疗效满意,髋关节功能恢复效果好,并发症少,其远期并发症尚有待进一步随访观察。

Objective To compare and analyze of artificial hip arthroplasty and internal fixation for elderly patients with unstable intertrochanteric fractures.Methods 100 elderly patients with unstable intertrochanteric fractures in Daqing Oilfield General Hospital from January 2009 to September 2012 were selected and divided into 4 groups,22 cases in group A were treated with artificial hip arthroplasty,28 cases in group B were treated with PFNA internal fixation,26 cases in group C were treated with DHS,24 cases in group D were treated with Gamma internal fixation. Harris score of hip function were compared,complications were observed.Results Harris scores of the 4 groups in a time point after operation were higher than those in the former time point,the differences were statistically significant（P 0.05）;Harris scores of group A in same time point were higher than those of other groups,the differences were statistically significant（P 0.05）;Harris scores of group B in same time point were higher than those of group C and group D,the differences were statistically significant（P 0.05）;the differences of Harris scores of group C and group D in same time point were not statistically significant（P 0.05）.The occurrence of complications such as varus deformity,nonunion,delayed union,loosening of internal fixation were not found during following-up period in group A; implant loosening,fracture and hip varus deformity were not found in group B during following-up period;2 cases of loosening of internal fixation and 3 cases of varus deformity were found in group C;1 cases of nail distal femoral shaft fracture（type Ⅱ） and 1 case of pain in the upper end of the thigh were found in group D.Conclusion Artificial hip arthroplasty has better recovery,fewer recent complications than internal fixation;it needs more follow-up to observe the long-term complications.