关节置换及内固定治疗高龄股骨转子间骨折疗效比较

目的比较人工股骨头置换与骨折内固定治疗高龄股骨转子间骨折的临床疗效。方法将1996年6月至2004年4月间收治的108例80岁以上新鲜不稳定性股骨转子间骨折的患者分为A、B两组。A组为行人工股骨头置换者,B组为行骨折内固定者。A组50例,平均年龄86.5岁;B组58例,平均年龄83.5岁。A组随访12~60个月,平均35.5个月;B组随访12~24个月,平均14.5个月。结果两组在手术时间、术中出血量、术后引流量的比较,差异无统计学意义(P>0.05)。在住院时间、术后开始下地时间、术后早期并发症、术后内科合并症及功能恢复等方面进行比较,差异有统计学意义(P<0.05)。与B组比较,A组住院时间短,负重活动早,功能恢复快,术后并发症少。结论人工股骨头置换术治疗高龄股骨转子间骨折是一种较为理想的选择,具有以下优点a)术后能早期负重活动,较快恢复伤前活动能力;b)降低术后并发症和内科合并症的发生率;c)能有效防止髋内翻;d)缩短住院时间;e)提高老年人晚年的生活质量。

Comparison between Prosthetic Replacement and Internal Fixations for Treatment of Femoral Intertrochanteric Fracture in the Elderly

Objective To compare the curative effects of the prosthetic replacement(PR)and internal fixations(IF)in the treatment of the femoral intertrochanteric fractures in the elderly. Methods From June 1996 to April 2004, 108 patients over 80 years with unstable femoral intertrochanteric fracture were divided into 2 groups(A and B). The patients in group A(n=50, average age 86.5 years) were performed prosthetic replacement(PR). The follow-up period ranged from 12 to 60 months(mean 35.5 months). The patients in group B(n=58, average age 83.5 years) were performed internal fixation(IF). The follow-up period ranged from 12 to 24 months(mean 14.5 months). Results The differences of the operative time, blood loss, drainage between the two groups were of no statistical significance(P>0.05). The differences of the time of hospitalization, ambulation time, early complication, medical diseases and restored function after operation between the two groups were of statistical significance(P<0.05). Comparing with the group B, the group A was of shorter time of hospitalization, earlier full weight-bearing,rapid rehabilitation and fewer post-operative complications. Conclusion In the treatment of unstable femoralintertrochanteric fractures in the elderly, PR is a ideal selection. PR can provide early full weight-bearing and rapidrehabilitation, reduce the incidence of post-operative complications and medical diseases, avoid the severe coxa varaand improve the life quality in the eigerly.