股骨近端防旋髓内钉与骨水泥半髋置换治疗老年股骨转子间骨折的临床疗效比较

Comparison between proximal femur nailing and hemiarthroplasty in treating intertrochanteric femur fractures in the elderly

目的比较股骨近端防旋髓内钉与骨水泥半髋置换治疗老年股骨转子间骨折的临床疗效,重点比较术后18个月内的功能。方法于2011年1月—2013年12月选取年龄≥75岁的老年股骨转子间骨折患者60例。随机分为2组,内固定组(35例)行股骨近端防旋髓内钉固定,关节置换组(25例)行骨水泥双动股骨头置换。比较两组手术时间、术中出血量、住院时间、术后并发症的发生及术后功能,功能评价采用Harris评分。结果内固定组和关节置换组术中出血量分别为(124.7±23.4)、(207.5±19.4)m L,手术时间分别为(41.7±8.1)、(64.2±7.3)min,组间差异均有统计学意义(P<0.05)。两组并发症发生率差异无统计学意义(P>0.05)。出院时和出院3个月时两组Harris评分差异有统计学意义(P<0.05),关节置换组高于内固定组;出院6个月时两组Harris评分差异无统计学意义(P>0.05);出院12和18个月时两组Harris评分差异有统计学意义(P<0.05),内固定组高于关节置换组。结论使用内固定治疗股骨转子间骨折最终可获得更佳的功能,有利于患者生活质量的提高,且内固定治疗操作更简便,不增加并发症发生。

Objective To compare proximal femur nailing and hemiarthroplasty in the treatment of intertrochanteric femur fractures in the elderly. Methods The study included 60 patients at the age of 75 or above who were diagnosed with intertrochanteric femur fracture between January 2011 and December 2013. After informed consent was obtained from the patients, they were randomized into two groups. Patients in internal fixation group （n=35） were internally fixated with proximal femoral nail, while patients in hemiarthroplasty group （n =25） were treated with cemented hemiarthroplasty. Complications, surgery time, hospital stay, postoperative function and blood loss during the surgery were recorded and functional results were evaluated using Harris Hip Score. Results Blood loss in the internal fixation group and the hemiarthroplasty group was respectively （124.7＋23.4） and （207.5＋19.4） mL, and the surgery time was （41.7＋8.1） and （64.2＋7.3） minutes, and the differences were significant （P〈0.05）. There was no significant difference in terms of complications between the two groups （P〉0.05）. Harris Hip Score analysis revealed that the difference between the patients treated with hemiarthroplasty and proximal femoral nailing was statistically significant in favor of the hemiarthroplasty group within the first 3 months. However, this difference diminished at the 6th month time point （P〉0.05）, and even reversed at the 12th month postoperatively （P〈0.05）. Conclusions Internal fixation with proximal femoral nail displays a better level of activity in the end in the treatment of intertrochanteric femur fractures. It is helpful for the patients to improve their life quality with convenient operation and less invasion.