人工关节置换术与内固定术在老年股骨转子间骨折患者中的治疗效果对比分析

Comparative analysis on treatment effect of artificial joint replacement and internal fixation in elderly patients with intertrochanteric fracture

目的对比人工关节置换术与内固定术在老年股骨转子间骨折患者中的治疗效果。方法 96例接受手术治疗的股骨转子间骨折老年患者,按照随机数字表法分为人工髋关节置换组与内固定组。记录并比较两组患者的切口长度、手术时间、术中出血量、术后下地时间、早期并发症发生情况及术后12个月后Harris髋关节功能评分。结果人工髋关节置换组的切口长度为(10.5±1.8)cm、术中出血量为(205.7±56.3)ml及手术时间为(70.2±5.3)min,与固定组的(7.3±2.1)cm、(145.3±44.5)ml、(60.3±6.1)min比较,差异具有统计学意义(t=8.016、5.831、8.488,P<0.05)。人工髋关节置换组患者的术后下地时间及早期并发症发生例数显著优于内固定组,差异具有统计学意义(P<0.05)。人工髋关节置换组疼痛、功能、畸形、活动度以及总分分别为(35.2±3.4)、(36.7±4.5)、(3.2±0.5)、(3.1±0.4)、(78.8±3.2)分,内固定组各项评分分别为(28.1±2.6)、(22.8±3.1)、(3.1±0.9)、(3.0±1.1)、(57.1±4.3)分;两组患者畸形和活动度评分比较差异无统计学意义(P>0.05);人工髋关节置换组的疼痛、功能及总分明显高于内固定组,差异具有统计学意义(P<0.05)。结论人工关节置换具有术后下床时间短、早期并发症少、髋关节功能恢复好等优点,是治疗老年股骨转子间骨折的有效方法。

Objective To compare the treatment effect of artificial joint replacement and internal fixation in elderly patients with intertrochanteric fracture.Methods A total of 96 elderly patients with intertrochanteric fracture undergoing surgical therapy were divided by random number table method into artificial joint replacement group and internal fixation group,with 48 cases in each group.Record and comparison were made on length of incision,operation time,intraoperative bleeding volume,postoperative off-bed time,occurrence of early complications and Harris hip function score in postoperative 12 months between two groups.Results Artificial joint replacement group had length of incision as（10.5±1.8） cm,intraoperative bleeding volume as（205.7±56.3） ml and operation time as（70.2±5.3） min,which were all obviously better than（7.3±2.1） cm,（145.3±44.5） ml and（60.3±6.1） min in internal fixation group,and their difference was statistically significant（t=8.016,5.831,8.488,P〈0.05）.Artificial joint replacement group had obviously better postoperative off-bed time and cases of early complications than internal fixation group,and the difference was statistically significant（P〈0.05）.Artificial joint replacement group had pain,function,deformity,activity score and total score respectively as（35.2±3.4）,（36.7±4.5）,（3.2±0.5）,（3.1±0.4） and（78.8±3.2） points,which were（28.1±2.6）,（22.8±3.1）,（3.1±0.9）,（3.0±1.1） and（57.1±4.3） points in internal fixation group.Both groups had no statistically significant difference in deformity and activity score（P〉0.05）.Artificial joint replacement group had obviously higher pain and function score and total score than internal fixation group,and their difference was statistically significant（P〈0.05）.Conclusion Artificial joint replacement has the advantages of shorter postoperative off-bed time,less early complications and better functional recovery of hip function.It is an effective method for the treatment of elderly intertrochanteric fracture.