双极股骨头置换结合张力带钢丝固定治疗高龄骨质疏松性股骨转子间骨折临床研究

Clinical study of bipolar hemiarthroplasty and tension band wire fixation in therapy for elderly os-teoporotic intertrochanteric fracture

目的：研究双极股骨头置换结合张力带钢丝固定治疗高龄骨质疏松性股骨转子间骨折的临床效果。方法选取2012年6月至2015年1月接收的82例老年骨质疏松性股骨转子间骨折患者作为研究对象，根据手术方式将其分为股骨头置换组与动力髋螺钉组，每组41例。动力髋螺钉组采用动力髋螺钉治疗，股骨头置换组采用双极股骨头置换结合张力带钢丝固定治疗。对比观察两组患者治疗效果、手术情况、并发症发生情况及髋关节功能评分和骨质疏松评分变化情况。结果股骨头置换组优良率、并发症发生率分别为95.12%、2.44%，动力髋螺钉组分别为92.69%、2.44%，两组比较差异未见统计学意义（P 〉0.05）；股骨头置换组术中出血量及手术时间均明显少于动力髋螺钉组，差异有统计学意义（P 〈0.05）；两组患者术后3、5个月时股骨头置换组髋关节功能评分明显优于动力髋螺钉组，差异有统计学意义（P 〈0.05）；治疗前两组患者各区域骨密度比较差异未见统计学意义（P 〉0.05），治疗后两组患者股骨大转子、股骨颈及 Ward 三角区域骨密度均明显优于治疗前，差异有统计学意义（P 〈0.05）。结论采用双极股骨头置换结合张力带钢丝固定治疗高龄骨质疏松性股骨转子间骨折效果显著，手术时间及术中出血量少，并发症发生率低，可有效改善患者髋关节功能及骨质疏松症状，提高治疗效果。

Objective To analyze the clinical effect of bipolar hemiarthroplasty and tension band wire fixation on elderly osteoporotic intertrochanteric fractures. Methods Eighty-two elderly patients with osteoporotic intertrochanteric fracture from June 2012 to January 2015 were selected as the research objects according to the operation method,they were divided into femoral head replacement group and dy-namic hip screw group,with 41 cases in each group. The dynamic hip screw group was treated with dy-namic hip screw,and the femoral head replacement group was treated with bipolar femoral head replace-ment combined with tension band wire fixation. The treatment effects,operation condition,complications and hip function score and the incidence of osteoporosis were observed and compared between the two groups. Results The excellent and good rate was 95. 12% ,the complication rate was 2. 44% in femoral head replacement group ,and they were respectively 92. 69% ,2. 44% in dynamic hip screw group, there was no significant difference between the two groups（P 〉 0. 05）. The intraoperative hemorrhage volume and operation time in femoral head replacement group were significantly less than those in the dy-namic hip screw group,the differences were significant（P 〈 0. 05）. The hip function score of the femo-ral head replacement group was significantly better than that of the dynamic hip screw group at 3 and 5 months after operation ,the differences were significant（P 〈 0. 05）. The regional BMD had no signifi-cant difference between the two groups before treatment（P 〉 0. 05）,after treatment,the femoral greater trochanter,femoral neck and ward’s triangle region bone mineral density in femoral head replacement group were significantly better than those of dynamic hip screw group,the differences were significant （P 〈 0. 05）. Conclusions The effect of bipolar hemiarthroplasty and tension band wire fixation on＆amp;nbsp;bone elderly osteoporotic intertrochanteric fracture is remarkable,it has shorter operative time,less blood loss,fewer complication,so it can effectively improve the patients’hip function and osteoporosis symp-toms,improve the therapeutic effect.