胸骨钢丝捆绑与钢板固定大转子方式在不稳定股骨转子间骨折 患者人工股骨头置换术中的应用及疗效比较

目的：观察不稳定股骨转子间骨折老年患者人工股骨头置换术中采用胸骨钢丝捆绑和钢板固定大转子方式的疗效，为其治疗提供依据。方法：52例高龄转子间不稳定骨折患者，依据大转子处骨折粉碎程度分为胸骨钢丝捆绑组（采用胸骨钢丝捆绑固定大转子，n=28）和钢板固定组（采用钢板固定大转子，n=24）。观察2组患者的手术时间，出血量，术后引流量，患者初次下地时间，术后并发症发生率，出院时和术后1个月、3个月、6个月、12个月髋关节功能的Harris评分。结果：胸骨钢丝捆绑组患者手术时间少于钢板固定组（P<0.05）；出血量少于钢板固定组（P<0.05）；术后引流量，患者初次下地时间，术后并发症发生率，出院时和术后1个月、3个月、6个月、12个月髋关节功能的Harris评分组间比较差异无统计学意义（P>0.05）。结论：与钢板固定大转子比较，不稳定股骨转子间骨折患者人工股骨头置换术中采用胸骨钢丝捆绑固定大转子具有手术时间短、术中出血少、术后髋关节功能恢复好的优势，适于临床推广。

Comparison of application and curative effects between sternal wire binding and plate fixation of greater trochanter in artificial femoral head replacement of patients with unstable intertrochanteric fracture

Objective:To observe the curative effects of artificial femoral head replacement using sternal wire binding and plate fixation in the treatment of the patients with unstable intertrochanteric fracture, and to provide the basis for its treatment. Methods:A total of 52 elderly patients with intertrochanteric fracture treated with artificial femoral head replacement were divided into sternal wire binding group (the patients were given sternal wire binding of greater trochanter,n=28) and plate fixation group (the patients were given plate fixation of greater trochanter,n=24). The operation time, blood loss, the drainage volumes after operation, the time of getting off the bed first, the incidences of early complications, and the Harris scores of hip joint at the discharge time and 1 month, 3 months, 6 months and 12 months after operation of the patients in two groups were recorded. Results:Compared with plate fixation group, the operation time of the patients in sternal wire binding group was decreased (P<0.05), the blood loss of the patients in sternal wire binding group was decreased (P<0.05), but there were no significant differences in the drainage volumes after operation, the time of getting off the bed first, the incidences of complications after operation, and the Harris scores of hip joint at the discharge time and 1 month,3 months, 6 months, and 12 months after operation of the patients between two groups(P>0.05). Conclusion:Compared with plate fixation, sternal wire binding of the greater trochanter in femoral head replacement in the treatment of the patients with unstable intertrochanteric fracture has the advantages of shorter operative time, less blood loss volume,better postoperative recovery of hip joint function,which is suitable for the clinical application.