动力髋螺钉、股骨近端防旋髓内钉及人工髋关节置换修复老年股骨转子间骨折

背景：有研究认为对于不稳定型股骨转子间骨折并有严重疏松且不能耐受关节置换的患者,髓内固定为首选;对于高龄不稳定骨折,严重骨质疏松,术前可行走,能耐受一次较大手术者可首选人工股骨头置换;而对骨折稳定、骨质疏松不严重、身体状况较好者也可选用动力髋螺钉髓外固定.目的：对比分析动力髋螺钉、股骨近端防旋髓内钉及人工髋关节置换不同植入物修复老年股骨转子间骨折的临床效果.方法：将120例股骨转子间骨折老年患者随机分为动力髋螺钉组、股骨近端防旋髓内钉组和人工髋关节组,其中动力髋螺钉组45例,股骨近端防旋髓内钉组40例,人工髋关节组35例,对3组患者的术中出血量、手术时间、住院时间以及住院期间并发症和治疗优良率等指标进行对比观察.结果与结论：股骨近端防旋髓内钉组的手术时间、术中出血量以及治疗优良率均明显优于其他两组,差异有显著性意义（P＜0.05）.此外,股骨近端防旋髓内钉组住院期间并发症也明显少于其他两组,差异有显著性意义（P＜0.05）.提示股骨近端防旋髓内钉修复老年股骨转子间骨折的临床效果明显优于动力髋螺钉和人工髋关节置换,具有术中出血量少、手术时间短、治愈率高等优点,并能显著改善患者的生活质量.

Dynamic hip screw,proximal femoral anti-rotation nail and artificial hip joint replacement in repair of intertrochanteric fractures in the elderly

BACKGROUND： For patients with unstable intertrochanteric and severe osteoporosis who cannot tolerate arthroplasty, intramedullary fixation is the first choice. For patients with elderly unstable fracture and severe osteoporosis, who can walk before surgery, and tolerate a large surgery, artificial femoral head replacement is the first choice. For patients with stable fracture and good physical status, whose osteoporosis is not serious, dynamic hip screw extramedullary fixation can be used.
OBJECTIVE： To compare and analyze clinical efficacy of dynamic hip screw, proximal femoral anti-rotation nail and hip replacement implants for treatment of intertrochanteric fractures in the elderly.
METHODS： 120 elderly patients with intertrochanteric fractures were randomly divided into dynamic hip screw group, proximal femoral anti-rotation nail group and artificial hip joint group. There were 45 cases in the dynamic hip screw group, 40 cases in the proximal femoral anti-rotation nail group and 35 cases in the artificial hip joint group. Intraoperative blood loss, time of surgery, length of hospital stay, complications during hospitalization and the excellent and good rate of treatment were compared and observed.
RESULTS AND CONCLUSION： Operative time, intraoperative blood loss and the excellent and good rate of treatment were significantly better in the proximal femoral anti-rotation nail group than that in the other groups （P 〈 0.05）. Moreover, the complications during hospitalization were significantly less in the proximal femoral anti-rotation nail group than those in the other groups （P 〈 0.05）. Above data indicated that the clinical effects of proximal femoral anti-rotation nail were apparently better than dynamic hip screw and artificial hip joint in repair of elderly intertrochanteric fracture. Proximal femoral anti-rotation nail is characterized by less intraoperative blood loss, short operative time, and high surgical cure rate, and can evidently improve patient’s quality of life.