人工股骨头置换与DHS内固定治疗老年股骨粗隆间骨折的对比研究

摘要

目的 对比人工双动股骨头置换术(FHR)与动力髋螺钉(DHS)治疗高龄不稳定股骨粗隆间骨折临床疗效.方法 收治70岁以上高龄股骨粗隆间骨折患者69例,随机选择股骨头置换或DHS内固定,其中采用DHS治疗47例(DHS组),FHR治疗22例(FHR组).记录手术时间、术中出血量、术后下床活动时间、住院时间,Harris评分及术后并发症.结果 随访6～25个月,在手术时间、术中出血量,两组比较差异无统计学意义(P＞0.05),但FHR组在术后下床活动时间、住院时间、髋关节功能、并发症发生率与DHS组比较有统计学意义(P＜0.01).结论 人工股骨头置换术具有允许术后早期负重活动、并发症发生率低和功能恢复满意等优点,是治疗高龄不稳定股骨粗隆间骨折较合理的方法之一.%Objective To investigate and discuss the feasibility and clinical outcome of femoral head replacement( FHR) in the treatment of femoral intertraochanteric fracture in the elderly,and analyze the two operation.Methods Sixty-nine patients were divided into two groups randomly.In dynamic hellop screw(DHS) group,47 patients were operated.In FHR group,22 patients were operated with laterd approach.Time of operation,the intraoperative bood loss,the time to leave bed were recorded, Harris hip score in 1 week, 1 month, days of staying at hospital, postoperative complications postopevatively were assessed.Results The patients were followed up from 6 to 25 months(average 17.3 months).in the operative time,intraoperative quantity by,FHR group and the DHS had no significant difference(P＞0.05) , but the replacement group postoperative activities,length of stay, hip function, concurrent disease incidence and internal fixation group had significant advantage(P＜0.01).Conclusion Because of many virtues, such as earlier period activity out of bed , low incidence of complications , satisfaction of functional recovery, FHR is a reasonable preference for unstable intertrochanteric hip fracture in elder patients,and the key point is to master the indication and rational operation.