股骨头置换与内固定治疗高龄不稳定转子间骨折的比较研究

目的:比较股骨头置换与内固定治疗高龄不稳定股骨转子间骨折的临床疗效。方法:回顾性分析2016年1月至2019年1月收治的70例不稳定转子间骨折,采用闭合复位新型股骨近端髓内钉(InterTAN)固定39例,切开转子部重建人工股骨头置换31例。比较2组患者手术时间,术中出血量,住院时间,负重时间,术后并发症发生率及髋关节功能恢复情况(Harris评分)。结果:所有患者获得随访,时间12～24个月,两组术中出血量和住院时间差异均无统计学意义(P0.05),置换组手术时间较内固定组手术时间长(P0.05);置换组术后负重时间明显较内固定组早(P0.05)。置换组有1例肺部感染,1例深静脉血栓形成,1例假体周围骨折;内固定组有4例肺部感染,3例内固定失败,3例脑梗,2例泌尿系感染发生;两组比较差异有统计学意义(P0.05)。术后1个月置换组Harris评分高于内固定组(P0.05),而术后12个月两组Harris评分差异无统计学意义(P0.05)。结论:InterTAN和股骨头置换均可治疗高龄不稳定转子间骨折,但股骨头置换后可以早期下地活动,改善生命终末期的生活质量,减少术后并发症,利于内科共存疾病的治疗。

Comparative study of femoral head replacement and internal fixation in the treatment of unstable intertrochanteric fractures in the elderly

Objective: To compare the clinical efficacy of femoral head replacement and internal fixation in the treatment of unstable intertrochanteric fractures in the elderly.Methods: Retrospective analysis of 70 cases of unstable intertrochanteric fractures treated from January 2016 to January 2019 and meeting the inclusion and exclusion criteria,39 cases were fixed with closed reduction and new proximal femoral intramedullary nail(InterTAN),and 31 cases were treated with open trochanter reconstruction and artificial femoral head replacement. The operation time,intraoperative bleeding,hospital stay,weight-bearing time,postoperative complication rate and hip function recovery (Harris score) were compared between two groups.Results: All cases were followed up for 12 to 24 months. There were no significant differences in intraoperative bleeding and hospital stay between the two groups(P>0.05). The operation time in replacement group was longer than that in internal fixation group(P<0.05). The postoperative weight-bearing time in replacement group was significantly earlier than that in internal fixation group(P<0.05). In the replacement group,there were 1 case of pulmonary infection,1 case of deep venous thrombosis and 1 case of periprosthetic fracture;in the internal fixation group,there were 4 cases of pulmonary infection,3 cases of internal fixation failure,3 cases of cerebral infarction and 2 cases of urinary infection;there was significant difference between two groups(P<0.05). The Harris score in replacement group was higher than that in internal fixation group one month after operation(P<0.05),but there was no significant difference between two groups at 12 months after operation(P>0.05).Conclusion: InterTAN and femoral head replacement can treat unstable intertrochanteric fractures in the elderly,but femoral head replacement can move down early,improve the quality of life at the end of life,reduce postoperative complications and facilitate the treatment of coexisting diseases in internal medicine.