不同方案治疗老年严重骨质疏松股骨转子间骨折的疗效和安全性的对比

Comparison of the efficacy and safety of different treatment regimens in elderly patients with severe osteoporosis intertrochanteric fractures elderly

目的探讨髓内钉固定术与人工关节置换术治疗老年严重骨质疏松股骨转子间骨折患者的临床疗效及安全性。方法选取2009年7月至2013年6月本院收治的80例老年严重骨质疏松股骨转子间骨折患者,随机分为关节置换组和髓内钉固定组两组,每组各40例,关节置换组采取人工关节置换术治疗,髓内钉固定组采取髓内钉固定治疗。对两组老年患者的手术切口长度、手术时间、出血量、康复锻炼时间、深静脉血栓形成以及肺部感染的发生率等情况进行观察记录。评定两组的疗效及患者的生活质量。结果关节置换组的手术时间为(55.39±7.85)min,明显低于髓内钉固定组的(60.62±8.49)min;关节置换组的切口长度为(12.65±2.41)cm,显著长于髓内钉固定组的(8.53±2.36)cm;差异均有统计学意义(P<0.05)。但术中出血量及康复锻炼时间两组间相比较,差异均无统计学意义(P>0.05)。关节置换组患者术后14d、术后3个月及6个月时的Harris评分明显高于髓内钉固定组;关节置换患者术后半年生活质量总评分显著高于髓内钉固定组;关节置换组患者术后深静脉血栓形成以及肺部感染发生率均显著低于髓内钉固定组,差异均具有统计学意义(P<0.05)。结论对严重骨质疏松股骨转子间骨折的老年患者而言,采取人工关节置换术治疗相比于髓内钉固定治疗在提高术后早期的治疗效果、缓解疼痛、改善患肢活动度、促进骨折愈合、降低术后并发症的发生率、提高患者的生活质量等方面具有显著的优越性。

Objective To investigate the clinical efficacy and safety of intramedullary nail fixation and arthro-plasty treatment for the elderly patients with severe osteoporosis intertrochanteric fracture .Methods From July 2009 to June 2013 in our hospital 80 cases of intertrochanteric fractures in elderly patients with severe osteoporosis femoral arthroplasty were selected and randomly divided into arthroplasty group and intramedullary nailing group ,40 cases in each group ,arthroplasty group took arthroplasty treatment .Intramedullary nailing group take intramedullary nail fix-ation treatment .The cases of two elderly patients and surgical incision length and time ,blood loss ,rehabilitation exer-cise time ,deep vein thrombosis and pulmonary infection rates were observed and recorded .Assess the efficacy and quality of life in both groups of patients .Results The surgery time of the arthroplasty group is （55 .39 ± 7 .85） min , significantly lower than （60 .62 ± 8 .49） min belongs to the intramedullary nailing group ;the surgery length of the ar-throplasty group is （12 .65 ± 2 .41） cm ,significantly longer than （8 .53 ± 2 .36） cm belongs to the intramedullary nail-ing group ;and the intramedullary differences are both statistically significant （P〈0 .05） .However ,compared with the two groups of the blood loss and rehabilitation exercise time ,the differences are not statistically significant （P〉0 .05） .14 d ,3 months and 6 months after the arthroplasty postoperative patients′surgery ,the Harris scores are sig-nificantly lower than the intramedullary nailing group ;the scores of quality of life of the arthroplasty group′s pa-tients after six months are significantly higher than the intramedullary nailing group ;the levels of deep vein thrombo-sis and pulmonary infection of the mentarthroplasty group′s patients are significantly lower than the intramedullary nailing group and the differences are statistically significant （P〈0 .05） .Conclusion Among elderly patients with se-vere osteoporosis intertrochanteric fractures ,the artificial mentarthroplasty is set to take great advantages to the intr-amedullary nail fixation treatment over the improving early postoperative treatment ,relieving pain ,improving limb mobility ,promoting fracture healing ,reducing the incidence of postoperative complications and improving the pa-tients′quality of life .