高龄股骨转子间骨折保守治疗与四种手术治疗比较

Comparison of conservative treatment with four kinds of surgical treatment for intertrochanteric fracture in the elderly

[目的]比较保守治疗、锁定板、PFNA、半髋关节置换和全髋关节置换治疗高龄股骨转子间骨折的临床效果。[方法]收集2014年2月~2016年2月在本院治疗且符合标准的195例高龄转子间骨折患者的临床资料,按照随机数字表法分为5组:保守治疗组(甲组)、锁定板组(乙组)、PFNA组(丙组)、半髋关节置换组(丁组)和全髋关节置换组(戊组),比较五组患者总住院时间、手术时间、术中出血量、术后髋关节Harris功能评分、术后总并发症率。[结果]甲组的总住院时间高于其他四组,差异有统计学意义(P<0.05)。乙组和丙组患者总住院时间高于丁组和戊组(P<0.05),乙组患者手术时间、术中出血量显著高于其余三组(P<0.05);丁组患者手术时间显著短于其余三组(P<0.05),丙组和丁组术中出血量显著低于其余两组,差异均有统计学意义(P<0.05);术后3、6、12个月丁组和戊组患者髋关节Harris功能评分显著高于其余三组(P<0.05),甲组患者髋关节Harris功能评分显著低于其余四组(P<0.05);甲组、乙组、丙组、丁组、戊组患者总并发症发生率分别为41.67%、24.39%、23.26%、21.05%、21.62%,其中甲组总并发症率显著高于其余四组,差异均有统计学意义(P<0.05)。[结论]对高龄股骨转子间骨折采用保守治疗效果最差。选用内固定或关节置换治疗老年股骨转子间骨折均能获得较好临床疗效,但关节置换可早期下床及减少早期并发症的发生率。

[Objective] To compare clinical resuhs among conservative treatment, ]oeking plate, proximal femoral nail arrtiro- tation （PFNA）, hemiarthroplasty am｜ total hip arthrnplasty fi^r treatment of intertroehanteric fracture in the ehterly. [Method] From February 2014 to February 2016, 195 patients diagnosed as intertrochanteric fracture and met the criteria were included into this study in our hospital. In term of treatment received, the patients were divided into five groups, inclnding tire conserva- tive group （group A）, the loeking plate group （ group B ）, the PFNA group （ group C ）, the hemiarthroplasty group （group l）） and the total hip arthroplasty group （group E） using ranrlom number table method. Genera｜ information of the five groups were com- parable. The total hospital stay, operation time, blood loss, postoperative hip Harris fimetion seore and postoperatiw, complica- tion rate were compared among the five groups. [Results] The total hospital stay of the group A were statistically hmger than those of the other 4 gruups, additionally, those of the group B and group C were hmger than the group I） and group E with statisti- cally signifieant differences （P〈O.05）. The operation time and blood loss in the group B were significantly greater than those of the other three surgical groups （P〈O.05）. The operation time of the group D were significantly shorter than those of the other three surgical grnups （P〈O.05）. The l）lood loss in group C and group D were significantly less Ihan those of the other Iwo surgical groups （P〈O.05）.The l-tarris score of group I） and group E were significantly higher than those of tire other three groups at 3 months, 6 months and 12 months ＇after the operation （P〈0.05）. Cnnvet^ely the Harris seore of group A were significantly lower than those of the other groups at 3 months, 6 months and 12 months after the operation （P〈0.05）. The postoperative complication rate proved 41.7% in the group A, 24.4% in the group B, 23.3% in the grnup C, 21.1% in the group D and 21.6% in the group E. The group A had the highest complication rate among them （P〈0.05）. [Conclusion] For intertroehanteric fracture in the ehterly, the conservative treatment achieves poor conse- quence. Both internal fixation and arthroplasty are suitable treatment option with reliable elinical results. However, hip arthroplasty with advantage of early ambulation does effectively re- duce perioperative complieation in the ehterly.