动力髋螺钉内固定与髋关节置换治疗高龄股骨粗隆间骨折疗效比较

Comparison of clinical results between dynamic hip screwnd and hip replacement of elderly intertrochanteric fracture

目的探讨动力髋螺钉内固定(DHS)及人工髋关节置换术治疗高龄股骨粗隆间骨折的临床疗效。方法本组230例,发病原因146例跌倒伤,69例车祸伤。骨折按Evans分型:Ⅲ型99例,Ⅳ型131例。分别采用DHS、髋关节置换两种手术方法治疗,分析临床疗效。结果术后随访5~24个月,平均13.6个月,所有患者患髋功能恢复良好,局部疼痛明显缓解或消失,患肢负重行走无需扶拐。两组在引流量、术后下地时间等方面有显著性差异。采用髋关节功能Harris评分系统评定,两种手术方法之间有显著性差异。结论 DHS与人工髋关节置换均为治疗高龄股骨粗隆间骨折的有效方式,人工髋关节置换更有理论上的优势,但各有优缺点,综合考虑选择合适的治疗方案才能取得满意的疗效。

Objective To investigate the clinical curative effects in the treatment of the intertrochanteric fractures in elderly patients between dynamic hip screw(DHS) and hip replacement. Methods A total of 230 cases elderly who had suffer from intertrochanteric fracture(146 cases causes of fallen and 69 cases of traffic accident injury)were treated with internal fixation devices. According to Evans classification system, 99 cases were of type Ⅲ, 131 cases were of type Ⅳ. The fractures were treated by DHS and hip replacement, analyze the clinical effect. Results All the patients were followed up 5 to 24 months, an average of 13.6 months. Follow-ups showed that function of hip were good and reported significant pain relief and limb weight-bearing walking without crutches.The postoperative drainage,ambulation time were significant different between DHS and hip replacement groups. Two kinds of surgical methods had significant difference due to Harris scoring system. Conclusion Our study showed that DHS and Hip replacement were effective way to treated elderly intertrochanteric fractures, hip replacement has theoretical advantages over the DHS, but both methods have advantages and disadvantages, choosing suitable treatment can obtain satisfactory curative effect.