微创动力髋螺钉内固定与全髋关节置换治疗伴骨质疏松的老年股骨转子间骨折的疗效对比

Comparative analysis of efficacy of different treatments for osteoporotic femoral intertrochanteric fractures in the elderly

目的对比分析微创动力髋螺钉内固定与全髋关节置换治疗伴骨质疏松的老年股骨转子问骨折的临床疗效。方法回顾性分析本院2008年7月至2012年6月收治的56例伴骨质疏松的老年股骨转子间骨折患者的临床资料，将28例接受全髋关节置换术的患者作为实验组，28例接受微创动力髋螺钉的患者作为对照组。对比分析两组术中出血及术后引流量、手术时间、内置物松动情况、术后并发症的发生情况及临床疗效。结果实验组与对照组手术时间、术中出血及术后引流量、术后有限负重时间的差异比较有统计学意义[（96．37±20．42）min，（529．85±73．82）ml，（7．46±1．23）dVS（66．84±18．63）min，（152．79±37．35）ml，（14．32±2．62）d，t=5．653，24．117，12．542，P〈0．01]，两组FRS评分与Harris评分差异无统计学意义[（27．75±3．59）分，（89．84±4．17）分vs（26．41±3．16）分，（88．68±3．92）分，P〉0．05]；对照组高危骨质疏松组内置物松动率要明显高于低危组（66．7％VS18．8％，x2=4．745，P〈0．05），实验组高危骨质疏松组与低危组内置物松动情况比较差异无统计学意义（11．1％VS10．0％，P〉0．05）；实验组的并发症发生率要显著低于对照组（3．6％VS28．6％，x2=4．766，P〈0．05）。结论对于合并骨质疏松的老年股骨转子间骨折，应根据患者的个体情况及骨质疏松的程度选择手术方式，术后抗骨质疏松治疗也应得到重视。

Objective To compare the outcomes of total hip replacement and minimally invasive dynamic hip screw in treating osteoporotic femoral intertroehanterie fractures. Methods Retrospectively an- alyze the clinical data of 56 patients with osteoporotic femoral intertrochanteric fractures who came to our hospital from July, 2008 - June, 2012. Twenty eight eases who accepted minimally invasive dynamic hip screw were divided into the control group while 28 cases who accepted total hip replacement were divided in- to the experimental group. The blood loss and postoperative drainage, operative time, situation of implant loosening, the occurrence of postoperative complications and the clinical curative effect were compared be- tween two groups. Results The differences in operative time, blood loss, and postoperative drainage flow, limited weight-bearing after operation was statistically significant between two group[ （96. 37 ± 20.42）min, （529. 85 ±73.82） ml, （7.46 ± 1.23 ） d vs （66. 84 ± 18. 63） min, （ 152. 79 ± 37. 35 ） ml, （ 14. 32± 2.62） d, t = 5. 653, 24. 117, 12. 542, P 〈 0. 05 ]. The differences in FRS score and Harris score between two groups was not statistically significant [ （27. 75 ±3.59）, （89. 84 ±4. 17） vs （26. 41 ±3.16）, （88.68±3.92）, P 〉 0. 05 ]. The incidence in internal fixation loosening varied significantly with different degree of osteoporosis in the control group （66. 7% vs 18.8%,X2 =4. 745, P 〈0. 05） but not in the experimental group （ 11.1% vs 10.0%, P 〉0. 05）. Complication rate of the experimental group was significantly lower than the control group （3.6% vs 28.6% X2 =4.766, P 〈0. 05）. Conclusions For the elder patients with osteoporotic femoral intertrochanteric fractures, the：selection of surgical approach should be based on the patient individual circumstances and the degree of osteoporosis. In the same time, attention should be paid to anti-osteoporosis therapy after operation.