内固定术与人工髋关节置换术治疗老年股骨转子间骨折的疗效比较

Comparison of efficacy of internal fixation and artificial hip arthroplasty in the treatment of intertrochanteric fracture of femur in the elderly

目的比较内固定术与人工髋关节置换术治疗老年股骨转子间骨折的疗效。方法70例老年股骨转子间骨折患者,随机分为人工髋组和髓内钉组,每组35例。髓内钉组采用防旋股骨近端髓内钉内固定术治疗,人工髋组采用人工髋关节置换术治疗。比较两组患者髋关节功能、手术与康复指标、生活能力、术后并发症发生情况。结果术后3个月,人工髋组患者疼痛、功能、畸形、关节活动评分及总分分别为(36.98±5.26)、(37.85±6.01)、(2.69±0.89)、(3.16±0.63)、(82.13±8.15)分,均显著高于髓内钉组的(28.69±4.26)、(29.15±6.42)、(2.05±0.76)、(2.75±0.53)、(63.57±8.26)分,差异具有统计学意义(P<0.05)。人工髋组手术时间(68.36±9.36)min长于髓内钉组的(57.25±8.53)min,术中出血量(375.13±47.52)ml多于髓内钉组的(215.25±32.25)ml,下床活动时间(2.45±1.03)d、术后住院时间(10.63±4.13)d短于髓内钉组的(5.85±2.41)、(16.58±3.25)d,差异均具有统计学意义(P<0.05)。术后1、3个月,人工髋组卡氏(KPS)评分分别为(82.36±5.73)、(90.11±6.02)分,显著高于髓内钉组的(73.02±4.96)、(82.01±5.86)分,差异均具有统计学意义(P<0.05)。人工髋组术后并发症发生率为11.43%(4/35),显著低于髓内钉组的31.43%(11/35),差异具有统计学意义(P<0.05)。结论人工髋关节置换术可有效缩短老年股骨转子间骨折患者下床活动时间,加快术后康复进程,髋关节功能恢复效果更佳,且并发症风险相对较低,与内固定术相比更加安全、有效。

Objective To compare the efficacy of internal fixation and artificial hip arthroplasty in the treatment of intertrochanteric fracture of femur in the elderly.Methods A total of 70 elderly patients with intertrochanteric fracture of femur were randomly divided into artificial hip group and intramedullary nail group,with 35 cases in each group.The intramedullary nail group was treated with proximal femoral nail anti-rotation internal fixation,and the artificial hip group was treated with artificial hip arthroplasty.The hip function,surgery and rehabilitation indexes,living ability and postoperative complications were compared between the two groups.Results At 3 months after surgery,the pain,function,deformity,joint activity scores and total scores in the artificial hip group were(36.98±5.26),(37.85±6.01),(2.69±0.89),(3.16±0.63),and(82.13±8.15)points,which were significantly higher than(28.69±4.26),(29.15±6.42),(2.05±0.76),(2.75±0.53),and(63.57±8.26)points of the intramedullary nail group,and the differences were statistically significant(P<0.05).In the artificial hip group,the operation time(68.36±9.36)min was longer than(57.25±8.53)min in the intramedullary nail group;the intraoperative blood loss(375.13±47.52)ml was more than(215.25±32.25)ml in the intramedullary nail group;the off-bed activity time(2.45±1.03)d and postoperative hospitalization time(10.63±4.13)d were shorter than(5.85±2.41)and(16.58±3.25)d in the intramedullary nail group;all the differences were statistically significant(P<0.05).At 1 and 3 months after surgery,the Karnofsky performance scale(KPS)scores in the artificial hip group were(82.36±5.73)and(90.11±6.02)points,which were significantly higher than(73.02±4.96)and(82.01±5.86)points in the intramedullary nail group,and the differences were statistically significant(P<0.05).The postoperative complication rate in the artificial hip group was 11.43%(4/35),which was significantly lower than 31.43%(11/35)in the intramedullary nail group,and the difference was statistically significant(P<0.05).Conclusion Artificial hip arthroplasty can effectively shorten the off-bed activity time of elderly intertrochanteric fracture of femur,accelerate the postoperative rehabilitation process,with better functional recovery of the hip joint and relatively low risk of complications,which is safer and more effective compared with internal fixation.