股骨头置换术与髓内钉系统治疗老年转子间骨折的临床疗效比较

A comparison of clinical curative effect between femoral head replacement and intramedullary nail system of intertrochanteric fracture in geriatric patients

目的比较股骨头置换术与髓内钉系统治疗老年转子间骨折的临床疗效,为老年转子间骨折的手术方案选择提供一定的依据。方法选择该科2010年1月—2012年12月期间行股骨头置换术或髓内钉系统治疗的被诊断为股骨转子间骨折的80岁以上的老年患者,分为髓内钉组和股骨头置换组。共67例患者,其中男16例,女51例,平均年龄86.0岁。股骨头置换组共32例,平均年龄86.7岁;髓内钉组共35例,平均年龄85.4岁。分别记录各病例的手术时间,术中出血量,下地时间,近期并发症。另对患者进行随访,了解患者末次随访并发症,髋关节功能恢复情况及死亡情况。通过SPSS17.0分析各组数据,比较两组间的差异。结果两组间末次随访并发症,髋关节功能恢复情况及死亡情况无统计学差异(P>0.05),而手术时间,术中出血量,下地时间及近期并发症有统计学差异,股骨头置换组手术时间,术中出血量多于髓内钉组,下地时间早于髓内钉组(P<0.05),近期并发症低于髓内钉组病人。结论股骨头置换术和髓内钉系统在治疗老年转子间骨折时远期疗效无明显差异,但股骨头置换术能让患者早期下床,减少近期并发症,虽其手术创伤较大,但仍可作为治疗老年转子间骨折的一种方法。

Objective To compare the clinical curative effect between femoral head replacement and intramedullary nail system of inter-trochanteric fracture in geriatric patients.Methods From January 2010 to December 2012 there were many geriatric patients who were diagnosed intertrochanteric fracture.We chose 67 patients （16 males and 51 females）whose age was over 80 years and who accepted the surgical treatment.The average age of them was 86.0 years.And the surgical treatment was femoral head replacement or intramedul-lary nail.We assigned the patients into two groups according to the surgical treatment.The number of femoral head replacement group is 32 （9 males and 23 females）,and the number of intramedullary nail system group is 35 （7 males and 28 females）.We recorded the operative time,blood volume during operation,the allowing-weight-bearing time and the recent complications.And we also recorded the complications during the final follow-up-visit,postoperative recovery of hip function and mortality through telephone and outpatient de-partment.All the data were analyzed by SPSS 17.0.Results There were no differences in the complications found during final follow-up-visit,postoperative recovery of hip function and mortality（P 〉0.05）.But there were significant differences in operative time,blood volume during operation,the allowing-weight-bearing time and the recent complications between the two groups.The allowing-weight-bearing time,operative time,blood volume during operation,and the recent complications in femoral head replacement group were lower than those in intramedullary nail system group（P 〈0.05）.Conclusions Although the operative wound of femoral head replacement is bigger than that of intramedullary nail system,there were fewer recent complications in the geriatric patients who underwent femoral head replacement than those accepting intramedullary nail system,and also those patients accepting femoral head replacement were al-lowed to leave bed earlier than those who accepted intramedullary nail system.So we can choose femoral head replacement to cure inter-trochanteric fracture in geriatric patients.