加长型骨水泥双动头假体伴钢丝捆扎治疗高龄股骨粗隆间骨折

Comparative study of femoral intertrochanteric fracture treated by wire bound cemented bipolar femoral head replacement and sliding hip screw internal fixation

目的探究钢丝捆扎结合加长骨水泥型人工双动头置换术治疗高龄股骨粗隆间骨折的临床疗效和优势。方法纳入80例高龄股骨粗隆间骨折患者,按照手术方式分为观察组(钢丝捆扎结合加长骨水泥型人工双动头置换术,42例)和对照组(动力髋螺钉内固定术,38例)。评估手术时间、术中与术后失血量、卧床时间、疼痛VAS评分、髋关节Harris功能情况及并发症情况。结果观察组手术时间、术中与术后失血量高于对照组,组间比较差异有统计学意义(P<0.05)。观察组卧床时间明显较短,组间差异有统计学意义(P<0.05)。6个月及1年随访时,观察组VAS评分、Harris评分明显优于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率28.6%(12例);对照组并发症发生率63.2%(24例),差异有统计学意义(χ~2=9.13,P=0.003)。结论钢丝捆扎结合加长骨水泥型人工双动头置换术治疗高龄股骨粗隆间骨折,与动力髋螺钉内固定术比较,术中创伤大,但卧床时间短,可早期下地行功能锻炼,利于恢复正常生活,具有明显优势,值得临床推广。

Objective To explore the clinical effects and advantages of femoral intertrochanteric fracture treated by wire bound cemented bipolar femoral head replacement and sliding hip screw internal fixation. Methods 80 cases of patients with femoral intertrochanteric fracture were included in our study.All the patients were divided into the following two groups according to the surgical method: 42 cases in an experiment group and 38 cases in a control group, which were treated wire bound cemented bipolar femoral head replacement and sliding hip screw internal fixation, respectively. Some parameters such as surgical time,intraoperative blood loss, bed time, VAS score, Harris functional score and complications were evaluated.Results The surgical time, intraoperative and postoperative blood loss of the experimental group were higher than those of the control group, there was statistical difference between the two groups(P<0.05). The bed time of the experimental group was shorter than that of the control group, there was significant difference between the two groups(P<0.05). The VAS score and Harris score of patients in the experimental group during the follow-up at 6 months and 12 months were better than those of the control group. There was statistical difference in the complication rate, the VAS score and Harris score between two groups(P<0.05).The complication rate of the experimental group and the control group were 28.6% and 63.2%(χ~2=9.13,P=0.003). Conclusions Compared with dynamic sliding hip screw internal fixation, wire bound cemented bipolar femoral head replacement has intraoperative trauma, but short bed time, thus can be carried out early functional exercises, which has better clinical effect and is worthy of clinical promotion.