动力髋螺钉内固定与人工股骨头置换治疗高龄股骨转子间骨折短期疗效比较

目的 探讨动力髋螺钉(DHS)与人工股骨头置换(HA)治疗高龄转子间骨折的效果.方法 对行DHS内固定(90例)与HA(66例)的高龄顺转子间骨折患者临床资料进行回顾性研究,对比分析两组患者术后功能恢复及并发症情况.结合Tronzo-Evans骨折分型及Singh指数分级,探讨高龄转子间骨折治疗方式的选择.结果 对患者随访12～108个月.HA组较DHS组术后下地早,并发症发生率低,髋关节功能优良率高.在内固定失败率和假体松动率方面,HA组不仅在Ⅲ、Ⅳ型不稳定骨折和Singh指数在1～3级患者中明显低于DHS组,在Ⅰ、Ⅱ型稳定骨折和Singh指数在4～6级患者中亦明显低于DHS组(P<0.05).结论 HA治疗高龄顺转子间骨折短期疗效良好.结合Tronzo-Evans分型和Singh指数分级对高龄转子间骨折治疗具有指导意义,高龄转子间Ⅲ、Ⅳ型骨折首选HA治疗;对于严重骨质疏松Singh指数在1～3级的高龄患者,即使Ⅰ、Ⅱ型稳定骨折,也可首选HA治疗.

Comparison of the short-term therapeutic effect of dynamic hip screw internal fixation and hemiarthroplasty for intertrochanteric fractures in elderly patients

Objective To study the effect of dynamic hip screw(DHS) internal fixation and hemiarthroplasty(HA) for intertrochanteric fractures in elderly patients.Methods The clinical materials of 90 patients of DHS group and 66 patients of HA group were retrospectively studied.The restoration of function after operation and the complication rate were comparatively analyzed.With the clinical values of the combination of Tronzo-Evans classification and Singh index,the treatment for intertrochanteric fractures in elderly patients was determined.Results The patients were followed up for 12～108 months.The total complication rate in HA group was lower than that in DHS group with significant difference(P<0.05).The post-operative walking time of HA patients was shorter than that of DHS patients.The ratio of excellent daily activities of HA patients was higher than that of DHS patients.The internal fixation failure rate of DHS group was higher than prosthesis loosening rate of HA in Singh index 1～3 grade and Ⅲ and Ⅳ type fractures with significant difference(P<0.05),and it was the same to Singh index 4～6 grade and Ⅰand Ⅱtype fractures.Conclusions HA is a good therapy for intertrochanteric fractures in elderly patients.There are clinical values of the combination of Tronzo-Evans classification and Singh index in guiding treatment for intertrochanteric fractures in elderly patients.HA can be considered as the first choice for elderly patients with Ⅲ and Ⅳ type fractures,as well as Ⅰand Ⅱtype fractures with severe osteoporosis(Singh index 1～3 grade).