人工股骨头置换与加压滑动髋螺钉置入治疗高龄患者股骨转子间骨折的比较

目的：比较人工股骨头置换与加压滑动髋螺钉置入治疗高龄股骨转子间骨折的临床疗效。 方法：选择1997-06/2008-06绵阳市中心医院骨科收治的高龄新鲜不稳定型股骨转子间骨折患者60例，男31例，女29例；年龄75~91岁，平均82.6岁。其中行人工股骨头置换及加压滑动髋螺钉内固定治疗各30例，对比观察两组患者住院时间、手术时间、术中出血量、术后引流量、下地活动时间、术后早期并发症、术后内科合并症发展及术后髋关节功能恢复。 结果：60例患者均获得随访，随访时间8个月~9年，平均2.3年。两组患者住院时间和术后引流量相比，差异无显著性意义(P > 0.05)；而在手术时间、术中出血量、下地负重活动时间、术后早期并发症、术后内科合并症和髋关节功能恢复、术后1年内死亡率等方面，人工股骨头置换均优于加压滑动髋螺钉置入组(P < 0.05)。 结论：人工股骨头置换可以作为治疗高龄股骨转子间骨折的一种选择，与加压滑动髋螺钉相比，人工股骨头置换时间较短，短期并发症发生率低，置换后关节功能评价较好。

Curative effect of prosthetic replacement versus internal fixations for femoral intertrochanteric fracture in the elderly

OBJECTIVE: To compare the curative effect between prosthetic replacement and internal fixations for treatment of femoral intertrochanteric fracture in the elderly. METHODS: From June 1997 to June 2008, 60 patients with fresh unstable femoral intertrochanteric fracture were selected from Department of Orthopedics, Central Hospital of Mianyang, including 31 males and 29 females aged 82.6 years (ranging 75-91 years). Thirty patients were treated with prosthetic replacement, and the remainders were treated with internal fixation by dynamic hip screw. Hospitalization duration, operation time, blood loss, postoperative drainage, motion off the bed, early complications, internal complication and hip function restoration were compared between two treatments. RESULTS: All 60 patients were followed-up for 2.3 years (ranging 8 months to 9 years). No differences were found in terms of the time of hospitalization and drainage between the two groups (P > 0.05). The operation time, blood loss, ambulation time, early complication, medical diseases and restored function after operation, death rate within 1year after operation in prosthetic replacement group were superior over the internal fixation group (P < 0.05). CONCLUSION: Prosthetic replacement is an alternative in the treatment of fresh unstable femoral intertrochanteric fractures in the elderly. It can provide early full weight-bearing and rapid rehabilitation, reduce the incidence of post-operative complications and medical diseases, and reduce the death rate within 1 year after operation compared with internal fixation.