人工关节置换与髓内钉固定治疗高龄严重骨质疏松股骨转子间骨折的疗效比较

Hip arthroplasty versus intramedullary nailing for aged patients with intertrochanteric fracture andserious usteuporosis

目的比较人工关节置换与髓内钉固定治疗高龄严重骨质疏松股骨转子间骨折的疗效。方法回顾性分析2002年1月至2011年12月期间收治且获得随访的142例75岁以上、骨密度T值≤-2.5的股骨转子间骨折患者资料，根据治疗方式不同分为两组：关节置换组（89例），女51例；平均年龄为（80.3±4.5）岁；采用人工关节置换治疗。髓内钉组（53例），男22例，女31例；平均年龄为（79.6±5.7）岁；采用髓内钉固定治疗。比较两组患者的手术时间、切口长度、术中出血量，以及术后2周、3个月，6个月及12个月疼痛视觉模拟评分（VAS）、髋关节Harris评分及健康调查简表（SF-36）评分等。结果关节置换组患者的手术时间[（55.4±8.4）min]较髓内钉组[（60.6±11.6）min]短，切口长度[（12.7±2.3）cm]较髓内钉组[（8.5±2.3）cm]长，差异均有统计学意义（P〈0.05）。两组患者的术中出血量、功能训练时间比较差异均无统计学意义（P〉0.05）。术后2周、3个月及6个月关节置换组疼痛VAS评分明显低于髓内钉组，髋关节SF-36评分明显高于髓内钉组，差异均有统计学意义（P〈0.05）；术后12个月时两组患者以上项目比较差异均无统计学意义（P）0.05）。结论对于高龄严重骨质疏松股骨转子间骨折，人工关节置换治疗较髓内钉固定在提高患者生活质量方面更有优势。

Objective To compare the effectiveness of hip arthroplasth （HA） versus intramedullary nailing （IN） in the treatment of intertrochanteric fractures in aged patients with severe osteoporosis. Methods We retrospectively 142 patients with an age of more than 75 years and T value of bone density≤-2.5 who had been treated in our department from January 2002 to December 2011 for intertrochanteric fractures and completely followed up . They were divided into 2 groups according to the treatment they had received .In the HA group, there were 38 men and 51 women, with an average age of 80.3±4.5 years. In the IN group, there were 22 men and 31 women, with an average age of 79.6±5.7 years . The 2 groups were compared in terms of operation time, incision length, intraoperative blood loss, visual analogue scale （VAS） scores , Harris scores of the hip and scores of the 36-item Form Health Surey （SF-36） at 2 weeks, 3,6 and 12 months postoperation. Results The HYA group had significantly shorter operation time （55.4±8.4 minutes versus 60.6±11.6 minutes ）and significantly longer incision （12.7±2.3 cm versus 8.5±2.3 cm） than the IN group （P〈0.05）. There were no significant differences between the 2 groups in intraoperative blood loss or time for functional rehabilitation （P〉0.05）. At 2 weeks, 3 and 6 groups in intraoperative blood loss or time for functional rehabilitation （P〉0.05）. At 2 weeks, 3 and 6 months postoperation, the HA group had significantly lower VAS scores and significantly higher Harris and SF-36 scores than the IN group （P〈0.05）. However, such significant differences in the 3 sorts of scores were not observed at 12 months postoperation （P〉0.05）. Conclusion Hip arthroplasty may be more advantageous in increasing postoperative quality of life than intramedullary nailing for aged patients with intertrochanteric fracture and serious osteoporosis.