骨水泥型半髋关节置换治疗高龄股骨粗隆间骨折72例

72 Cases of Intertrochanteric Fracture in the Old Treated by Bone Cement Half Hip Replacement

目的 探讨三种不同的手术方法治疗股骨粗隆间骨折的疗效.方法 选择股骨粗隆间骨折72例,随机分为三组,骨水泥型半髋关节置换组、动力髋部螺钉组、股骨近端髓内钉组,观察术后早期下床活动时间、功能恢复程度、并发症等有何不同.结果 骨水泥型半髋关节置换组优势明显,与动力髋部螺钉组和股骨近端髓内钉组相比,A组手术后3～5天内可以床下活动,动力髋部螺钉组和股骨近端髓内钉组要以X光片达到临床愈合标准才可以下床.术后两周及术后1个月骨水泥型半髋关节置换组分别与DHS手术、PFN手术组比较μ=10.8284;9.3106.P均＜0.01,有高度显著性差异.动力髋部螺钉不同时段Harris髋关节功能评分P＜0.05,有显著性差异.术后DHS手术组感染1例,坠积性肺炎DHS手术组1例,PFN手术组1例;褥疮骨水泥型半髋关节置换组1例,DHS手术组3例,PFN手术组1例.结论 骨水泥型半髋关节置换治疗高龄股骨粗隆间骨折明显优于PFN及DHS两组,值得推广.

Objective To compare three different surgical methods of curative effect for the treatment of intertrochanteric fracture. Methods 72 cases of femoral intertrochanteric fracture were randomly divided into three groups, .the bone cement type half hip replacement group, dynamic hip screw group, and proximal femoral intramedullary nailing group. Observed the diffierences of the early postoperative ambulation time, degree of functional recovery and complications. Results The bone cement type half hip replacement group of obvious advantages. Compared with dynamic hip screw and proximal femoral intramedullary nailing group, the patients of group A can do ambulation in 3 to 5 days after the surgery, dynamic hip screw and proximal femoral intramedullary nailing group to X-rays reach the standard of clinical healing can get out of bed. After 2 weeks and 1 month after bone cement type half hip replacement group respectively with dynamic hip screw and proximal femoral intramedullary nailing group compare μ =10.8284; 9.3106.P〈0.01, there are highly significant difference. Different time intervals of the dynamic hip screw Harris hip function score （P〈0.05）. There are significant differences. Postoperative dynamic hip screw group 1 cases of infection, hypostatic pneumonia group dynamic hip screw in 1 case, proximal femoral intramedullary nailing group 1 case; Bedsore bone cement type half hip replacement group in 1 case, group dynamic hip screw （3 cases）, proximal femoral intramedullary nailing group in 1 case. Conclusion The bone cement type half hip replacement is obviously better than the treatment of senile intertrochanteric fracture dynam- ic hip screw and proximal femoral intramedullary nailing in the two groups, is worth promoting.