股骨近端髓内钉与人工髋关节置换修复股骨转子间骨折的对比

Comparison of proximal femoral intramedullary nail and hip arthroplasty in the treatment of intertrochanteric fracture

背景:股骨转子间骨折多发于骨质疏松的老年患者,常用的治疗方法有髓内、外固定治疗和关节置换等。目的:对比股骨近端髓内钉与人工髋关节置换两种方法治疗股骨转子间骨折的临床疗效。方法:将菏泽市立医院在2009年8月至2013年8月收治的股骨转子间骨折患者198例,分为股骨近端髓内钉固定组和人工髋关节置换组,各99例。股骨近端髓内钉固定组和人工髋关节置换组患者分别采用股骨近端髓内针固定和人工髋关节置换治疗。结果与结论:股骨近端髓内钉固定组患者手术时间、术中出血量和住院时间均显著少于人工髋关节置换组,但骨折愈合时间显著长于人工髋关节置换组;但2组患者治疗后1年时的Harris评分、髋关节功能优良率和总并发症发生率差异无显著性意义。提示采用股骨近端髓内钉固定和人工髋关节置换治疗老年股骨近端骨折均有良好的生物相容性,均可取得良好的临床效果,2种方法虽各有优缺点,临床上均可根据患者病情需要制定合适的治疗方案。

BACKGROUND：Intertrochanteric fracture is often found in osteoporotic elderly patients, the commonly used treatment includes intramedul ary and extramedul ary fixations, and joint replacement. OBJECTIVE：To compare the clinical effect of proximal femoral intramedul ary nail and hip arthroplasty in the treatment of intertrochanteric fracture. METHODS：198 patients of intertrochanteric fracture recruited from Heze Municipal Hospital from August 2009 to August 2013, were divided into two groups. Each group had 99 patients, receiving proximal femoral intramedul ary nail and hip arthroplasty, respectively. RESULTS AND CONCLUSION：The average operation time, intraoperative blood loss and hospital stays in the proximal femoral intramedul ary nail group were significantly shorter, while the healing time of fracture was significantly longer than that in the hip arthroplasty group. At postoperative 1 year, there was no statistical difference in the Harris score, the excel ent and good rate of hip function, and the overal incidence of complications between the two groups. Experimental findings indicate that, both proximal femoral intramedul ary nail and hip arthroplasty are biocompatible and effective in the treatment of intertrochanteric fracture, and each technique has their advantages and disadvantages, we should choose the proper technique according to the patient’s condition.