克氏针张力带固定加半髋置换与股骨近端防旋髓内钉治疗高龄不稳定股骨粗隆间骨折的比较

Comparison of Kirschner wire tension band fixation plus hemihip arthroplasty and proximal femoral antirotation intramedullary nail for the treatment of unstable intertrochanteric fractures in the elderly

目的比较股骨近端髓内钉抗旋转与骨水泥双极半关节成形术联合克氏针张力治疗老年不稳定股骨粗隆间骨折的临床疗效。方法回顾性分析2016年3月至2017年3月湖南省娄底市中心医院骨科收治的老年不稳定股骨粗隆间骨折患者60例,所有患者EvansJensen分型均为Ⅲ型及Ⅳ型。采用中股骨近端防旋髓内钉34例作为固定组,采用克氏针张力带固定加骨水泥型半髋关节置换26例作为置换组,采用Harris评分评估不同方案治疗老年不稳定股骨粗隆间骨折的临床疗效。结果固定组相对置换组而言,手术时间更短,术中出血量更少,术后引流量较少,差异有统计学意义(P<0.05)。固定组患肢开始负重时间长于置换组,差异有统计学意义(P<0.05)。固定组早期并发症发生率低于置换组,晚期并发症发生率高于置换组,差异有统计学意义(P<0.05)。置换组髋关节功能优良率高于固定组,差异有统计学意义(P<0.01)。结论股骨近端防旋髓内钉和克氏针张力带固定加骨水泥型假体置换治疗老年患者股骨粗隆间骨折,均具有显著疗效。临床上可综合患者骨折类型、骨质疏松程度,合并内科疾病情况等多方面考虑以选择合适的治疗方法。

Objective To compare the clinical outcomes of proximal femoral nailing anti-rotation versus cemented bipolar hemiarthroplasty combining Kirschner wire tension for unstable intertrochanteric fractures in the elderly.Methods From March 2016 to March 2017,60 elderly patients who suffered from Evans type Ill and IV unstable intertrochanteric fractures were retrospective analysed.34 cases of proximal femoral nail antirotation were used as fixation group,26 cases of Kirschner wire tension band fixation and cemented hemiarthroplasty were used as replacement group.Harris score was used to evaluate the clinical efficacy of different schemes in the treatment of elderly patients with unstable intertrochanteric fracture.Results The operating time and blood loss volumes in the replacement group were greater than the fixation group(P<0.05).The time to recover full weight beating in the fixation group were longer than the replacement group(P<0.05).Early complications rate in the replacement group was lower than the fixation group,but late complications rate in the replacement group was higher than the fixation group,there was significant difference between two groups(P<0.05).The excellent and good rate of hip joint function in the replacement group was higher than that in the fixation group(P<0.01).Conclusion Proximal femoral nailing anti-rotation and primary cemented hemiarthroplasty combining Kirschner wire tension were effective and reliable treatments for unstable intertrochanteric fractures in the elderly.Clinically,we can consider the fracture type,osteoporosis degree,combined with medical diseases and other aspects to choose the appropriate treatment method.