动力髋螺钉内固定与半髋关节置换治疗老年人股骨转子间骨折临床对比分析

目的对比动力髋螺钉内固定与半髋关节置换治疗老年人股骨转子间骨折的临床效果,并分析优缺点。方法 2006年1月至2009年12月用动力髋螺钉（DHS）内固定治疗49例,半髋关节置换治疗31例,对手术时间、术中和术后出血量、下床活动时间、早期Harris评分及6个月、1年Harris评分、术后并发症进行比较。结果 80例全部得到随访,时间12～48个月,平均20.6个月。2组间在手术时间和出血量比较差异无统计学意义（P〉0.05）。半髋关节置换组的术后卧床时间较动力髋螺钉（DHS）内固定组短;半髋关节置换组术后早期Harris评分较动力髋螺钉（DHS）内固定组高,2组间比较差异有统计学意义（P〈0.05）。6个月、1年Harris评分2组间比较差异无统计学意义（P〉0.05）。术后并发症发生率半髋关节置换组较动力髋螺钉（DHS）内固定组发生率低,2组间比较差异有统计学意义（P〈0.05）。结论对于A1.1、A1.2、A1.3、A2.1型老年人股骨转子间骨折患者首选动力髋螺钉（DHS）内固定;骨折粉碎及骨质疏松严重的患者应选择半髋关节置换。

Dynamic Hip Screw in Treatment with Hemiarthroplasty Intertrochanteric Fracture of the Elderly Compared

Objective Comparison of dynamic hip screw fixation and hemiarthroplasty of intertrochanteric fractures of elderly patients with the clinical results,and analyze the advantages and disadvantages.Methods January 2006～December 2009 with a dynamic hip screw（DHS） fixation in 49 cases,half of hip arthroplasty in 31 cases,on the operative time,intraoperative and postoperative bleeding,time to get out of bed early Harris score and 6 months,1 year Harris score,postoperative complications were compared.Results All 80 patients were followed up for 12 to 48 months,an average of 20.6 months.Between the two groups in operative time and blood loss was no significant difference（P0.05）.Hemiarthroplasty group after bed time than dynamic hip screw（DHS） fixation was shorter;hemiarthroplasty group of early postoperative Harris scores in dynamic hip screw（DHS） high internal fixation group,the difference between the two groups statistically significant（P0.05）.6 months,1 year Harris score between the two groups was no significant difference（P0.05）.Postoperative complication rate compared with hemiarthroplasty group dynamic hip screw（DHS） fixation group had low.Difference between the two groups was statistically significant（P0.05）.Conclusion For the type A1.1、A1.2 type A1.3 type A2.1-based elderly patients with intertrochanteric fractures of the preferred dynamic hip screw（DHS） fixation;fractures and osteoporosis crushed to choose half of patients with severe hip joint replacement.