全髋关节置换与闭合复位外支架固定治疗老年股骨转子间骨折的中期疗效比较

Mid-term outcome of total hip arthropl asty and closed reduction external fixation in treatment of intertrochanteric fractures in the elderly

目的比较全髋关节置换(THR)与闭合复位外支架固定(CREF)治疗老年股骨转子间骨折的中期疗效。方法采用回顾性病例对照研究分析2011年6月至2019年6月陆军军医大学第二附属医院收治的155例单侧老年股骨转子间骨折患者临床资料,其中男63例,女92例;年龄70~98岁[(80.1±7.0)岁]。骨折Jensen-Evans分型:Ⅰ型2例,Ⅱ型21例,Ⅲ型24例,Ⅳ型36例,Ⅴ型67例,R型5例。85例接受THR治疗(THR组),70例接受CREF治疗(CREF组)。比较两组手术时间、术中出血量、输血率、住院时间、术后并发症发生率、术后1年髋关节功能Harris评分、髋关节功能优良率、术后生存质量12条简明健康状况调查问卷生理健康评分(SF-12PCS)、术后1年内病死率、随访终点生存曲线。结果随访时间1.0~9.5年[(3.9±2.4)年],140例患者获得1年以上随访,2例患者失访,13例患者在术后1年内死亡。THR组手术时间[77(60,100)min]及术中出血量[(290.6±182.3)ml]均长或大于CREF组[55(50,70)min、(30.5±25.0)ml](P<0.05)。THR组输血率[78%(66/85)]显著高于CREF组[21%(15/70)](P<0.05)。两组患者住院时间比较,差异无统计学意义(P>0.05)。THR组术后并发症发生率与CREF组差异无统计学意义(P>0.05)。术后1年,THR组Harris评分[(84.4±15.1)分]、髋关节功能优良率[76%(63/83)]及术后SF-12PCS[(16.2±1.0)分]均显著高于CREF组[(69.0±21.6)分、43%(27/63)、(14.1±2.2)分](P<0.05)。术后1年内两组病死率差异无统计学意义(P>0.05)。生存曲线分析显示,随访终点THR组生存状况优于CREF组(P<0.05)。结论相比CREF,THR治疗老年股骨转子间骨折具有更优的关节功能和生活质量,以及更高的总体生存率。

Objective To compare the mid-term clinical fficacy of total hip replacement(THR)and closed reduction and external fixation(CREF)in treatment of intertrochanterie fractures in the elderly.Methods A retrospective case-control study was conducted to analyze the clinical data of 155 elderly patients with unilateral intertrochanterie fractures admitted to Second Affiliated Hospital of Amy Medical University from June 2011 to June 2019,including 63 males and 92 females,aged 70-98 years[(80.1±7.0)years].Acconding to Jensen-Evans lassification,the type of fracture was type I in2 patients,type I1 in21,type I in 24,type IV in 36,type V in67,and type R in5.A total of 85 patients were treated by THR(THR Group)and 70 patients by CREF(CREF group).The operation time,intraoperative blood loss,blood transfusion rate,length of hospital stay,postoperative complication rate,Harris hip score at postoperative 1 year,excellent and good rate of hip joint function,and 12-item short form health survey(SF-12)physical component summary score(SF-12PCS)of postoperative quality of life,mortality rate within I year and survival rate were compared between the two groups.Results The fllow-up time was 1.0-9.5 years[(3.9±2.4)years].A total of,140 patients were followed up for more than one year,2 patients were lost,13 patients died within 1 year afer surgery.The operation time[77(60,100)minutes]and intraoperative blood loss[(290.6±182.3)ml]in THR group were significantly longer or more than those in CREF Group[55(50,70)minutes,(30.5±25.0)ml](P<0.05).The blood transfusion rate[78%(66/85)]in THR group was significantly higher than that in CREF Group[21%(15/70)](P<0.05).The lengh of hospital stay and incidence of postoperaive complications were similar between the two groups(P>0.05).One year afer operation,the Haris hip score[(84.4±15.1)points],excellent and good rate of hip joint function[76%(63/83)]and SF-12 PCS score[(16.2±10)points]in THR group were significantly higher than those in CREF group[(69.0±21.6)points,43%(27/63),(14.1±2.2)points](P<0.05).The morality within 1 year after operation was similar between the two groups(P>0.05).The survival curve analysis showed that the survival status in THR goup was better than that in CREF group(P<0.05).Conclusion Compared with CREF,THR has better joint function and quality of life,as well as a higher overall survival rate when applied to treat intertrochanteric fractures in the elderly patients.