人工髋关节置换术用于高龄患者股骨粗隆间骨折的临床效果

Application and analysis of the clinic effect of the artificial hip arthroplasty in treatment of elderly intertrochanteric fracture

目的 探讨行人工髋关节置换术在高龄股骨粗隆间骨折患者中的治疗效果。方法 2012年5月~2014年6月上海仁济医院收治的48例高龄股骨粗隆间骨折患者,根据随机数字表法将患者随机分为两组,每组各24例。观察组患者行人工髋关节置换术,对照组患者行股骨近端髓内钉内固定术（PFNA）。比较两组在手术时间、术中出血量、卧床时间、主动下床锻炼时间和临床疗效及术后总体并发症发生率。结果 所有患者均获随访,时间6~24个月,平均（12.0±3.0）个月。观察组患者的手术时间、卧床时间和主动下床锻炼时间均明显较对照组短（P〈0.05）;观察组术中出血量与对照组比较,差异无统计学意义（P〉0.05）;观察组患者的临床优良率（95.8%）优于对照组（75%）（P〈0.05）;观察组患者的术后总体并发症发生率（4.2%）比对照组（33.5%）低（P〈0.05）。结论 人工髋关节置换术在高龄患者股骨粗隆间骨折的治疗中较股骨近端髓内钉内固定术有较好的临床效果。

Objective To perspective analyze the clinical therapeutic effects of artificial hip arthroplasty for in- tertrochanteric fracture in elderly patients. Methods The clinical data of 48 cases of elderly patients with in- tertrochantefic fracture in Shanghai Renji hospital from May 2012 to June 2014 were collected and analyzed. 48 pa- tients were randomly divided into observe group （24 cases） and control group by random number table method. The ob- serve group was treated with hip replacement surgery, and the control group was treated with proximal femoral nail an- tirotation surgery. The surgical time, blood loss, bed time, out of bed time, clinical efficacy and incidence of postopera- tive complications between two groups were observed and compared. Results All the patients were followed up for 6-24 months, average （12.0±3.0） months. The surgical time, bed time, out of bed time of the observed group were significant- ly shorter （P 〈 0.05）. The blood loss between the two groups were similar （P 〉 0.05）. The clinical excellent efficacy rate of the observed group （95.8%） was higher than that of the control grnup （75.0%） （P 〈 0.05）. The postoperative compli- cation rate （4.2%） was lower than that of the control group （33.5%） （P 〈 0.05 ）. Conclusion Artificial hip arthroplasty for interochanterie fractures in elderly patients is more effective compared with proximal temoral nail antirotation.