全髋关节置换与股骨近端防旋髓内钉置入内固定修复老年股骨转子间骨折

背景：老年髋关节转子间骨折患者的治疗选择非常困难,内固定还是关节置换各有利弊,目前临床上比较内固定和关节置换两种方法的临床疗效较为多见,有研究认为全髋关节置换是高龄转子间骨折患者的首选。目的：比较全髋关节置换与股骨近端防旋髓内钉置入内固定治疗高龄股骨转子间骨折的疗效及并发症差异。方法：选择牡丹江医学院红旗医院骨二科高龄股骨转子间骨折患者67例,年龄65-87岁,按不同的治疗方案随机分为全髋关节置换组31例、股骨近端防旋髓内钉组36例,两组均采用常规固定入路。结果与结论：高龄股骨转子间骨折患者67例经切开复位内固定均获得成功。与股骨近端防旋髓内钉组相比,全髋关节置换组术中出血量增高,Harris评分和目测类比评分均明显改善（P〈0.05）,固定后卧床时间、内科并发症、髋部畸形率均减少（P〈0.05）。结果说明,全髋关节置换内固定治疗高龄股骨转子间骨折的疗效和安全性优于股骨近端防旋髓内钉置入内固定法。

Total hip replacement versus proximal femoral nail anti-rotation for repair of elderly intertrochanteric fracture

BACKGROUND： The treatment options of intertrochanteric fracture in elderly patients are very difficult, internal fixation and arthroplasty have their own advantages and disadvantages. The clinical efficacy of internal fixation and arthroplasty has been compared, and total hip replacement is the preferred choice for elderly patients with intertrochanteric fractures. OBJECTIVE： To compare the therapeutic effect and complications of total hip replacement and proximal femoral nail anti-rotation in elderly patients with intertrochanteric fracture. METHODS： 67 elderly patients with intertrochanteric fracture were selected from Second Department of Orthopedics, Hongqi Hospital of Mudanjiang Medical College, aged 65-87 years. According to the different treatment options, the involved patients were divided into total hip replacement group （n=31） and proximal femoral nail anti-rotation group （n=36）. Conventional fixation approach was performed in the two groups. RESULTS AND CONCLUSION： The open reduction and internal fixation were successfully performed in 67 elderly patients with intertrochanteric fractures. Compared with proximal femoral nail anti-rotation group, the intraoperative blood loss was increased, Harris scores and visual analog scores were obviously improved in the total hip replacement group （P 〈 0.05）; the postoperative bed time, medical complications and hip deformity were reduced （P 〈 0.05）. Total hip replacement is more effective and safer than proximal femoral nail anti-rotation in treatment of intertrochanteric fracture among elderly patients.