骨水泥柄人工股骨头置换与锁定钢板内固定治疗老年股骨粗隆间骨折效果分析

Efficacy comparison of stem cemented artificial femoral head replacement and locking compression plate fixation in the treatment of intertrochanteric femoral fracture in elderly patients

目的：比较骨水泥柄人工股骨头置换与锁定钢板内固定治疗老年股骨粗隆间骨折的效果,为临床治疗提供参考。方法：将南通大学附属建湖医院骨科2009年12月—2013年12月收治的60例符合选择标准的老年股骨粗隆间骨折患者纳入研究,分为骨水泥柄人工股骨头置换组（A组,n=30）及锁定钢板组（B组,n=30）,所有患者均合并骨质疏松,均无其他部位的骨折。术后随访12～36个月,平均26个月,对其进行临床评价,包括手术时间、术中出血量、住院时间、术后负重时间、并发症发生率及Harris评分。结果：术后患者切口均为Ⅰ期愈合,无神经、血管损伤,无下肢深静脉血栓形成等并发症发生。A组手术时间（60.3±9.2）min,术中出血（246.8±34.4）m L,住院时间（14.4±5.8）d,术后负重时间（5.8±1.4）d,并发症肺部感染1例,Harris评分由术前平均（42.4±3.2）分提高为术后3个月时的（85.2±6.8）分及术后12个月时的（95.2±3.3）分;B组手术时间（84.2±11.3）min,术中出血量（392.7±40.8）m L,住院时间（21.2±6.6）d,术后负重时间（75.2±14.2）d,并发症肺部感染2例,内固定失败4例,Harris评分由术前平均（43.7±4.5）分提高为术后3个月时的（64.6±7.2）分及术后12个月时的（93.4±4.6）分;两组在手术时间、术中出血量、住院时间、术后负重时间、并发症发生率及术后3个月的Harris评分比较差异均有统计学意义（均P〈0.05）,而术后1年的Harris评分比较差异无统计学意义（P〉0.05）。结论：骨水泥柄人工股骨头置换治疗老年股骨粗隆间骨折是安全有效的方法,手术操作简单、创伤小、卧床时间短、并发症少,术后患者可早期负重,有利于髋关节功能的恢复。

Objective： To compare the efficacy of stem cemented artificial femoral head replacement and locking compression plate fixation in the treatment of intertrochanteric femoral fracture in elderly patients. Methods： From Dec. 2009 to Dec. 2013,60 patients were divided into the stem cemented artificial femoral head replacement group（Group A, n=30） and the locking compression plate group（Group B, n =30）, who met the selection criteria of elderly femoral intertrochanteric fracture. All patients were complicated with osteoporosis and did not have fracture at other sites. The average follow-up period was 26 months, ranging from 12 to 36 months. Follow-up assessment included the operation time, amount of bleeding, hospitalization time, weight-bearing time after operation, postoperative complication rate and Harris score. Results： All patients＇ incisions obtained healing by first intention after operation. There was no neurovascular injury and thrombosis in deep veins of lower limbs. In group A, the operation time was（60.3±9.2） minutes, amount of bleeding was（246.8±34.4） m L, hospitalization time was（14.4±5.8） days, weight-bearing time after operation was（5.8±1.4） days, there was one case of pulmonary infection. The preoperative,3 months postoperative and final follow-up Harris scores of patients were（42.4±3.2）,（85.2±6.8）,（95.2±3.3） points respectively. In group B, the operation time was（84.2±11.3） minutes, amount of bleeding was（392.7±40.8） m L, hospitalization time was（21.2 ±6.6） days, weight-bearing time after operation was（75.2 ±14.2） days, there were two cases of pulmonary infection and four cases of failure of internal fixation. The preoperative,3 months postoperative and final follow-up Harris scores of patients were（43.7 ±4.5）,（64.6 ±7.2）,（93.4 ±4.6） points respectively. The operation time, amount of bleeding,hospitalization time, weight-bearing time after operation, postoperative complications and 3 months postoperative Harris score were statistically significant differenece between the two groups（P〈0.05）. The 12 months postoperative Harris score was not statistically significant differenece between the two groups（P〈0.05）. Conclusions： The stem cemented artificial femoral head replacement in the treatment of intertrochanteric femoral fracture in elderly patients is effective, simple operation with less injuries. It shortens hospitalization time and has less complications. Patients can walk early after operation and resume the ideal function of the hip joint.