人工股骨头置换与内固定治疗高龄不稳定型股骨转子间骨折45例

背景：高龄不稳定型股骨转子间骨折治疗主要目的是尽快恢复患者的负重功能，尽早离床活动、减少并发症的发生。那么人工股骨头置换治疗和内固定哪种治疗方法更适合高龄不稳定型股骨转子间骨折呢？ 目的：比较人工股骨头置换与内固定治疗高龄不稳定型股骨转子间骨折的临床疗效。 设计、时间及地点：回顾性病例分析，于2004-01/2008-08在吉林大学第一医院骨关节二科室完成。 对象：不稳定型股骨转子间骨折患者45例，按照不同治疗方法分为：人工股骨头置换组20例，内固定治疗组25例。 方法：人工股骨头置换组均采用侧卧位，取髋关节后外侧改良Gibson切口，采用第3代标准骨水泥技术，以便使骨质与骨水泥良好接触及假体牢固固定。内固定组采用仰卧位，外侧入路，常规行内固定。 主要观察指标：分别对两组的手术时间、术中失血量、术后并发症、卧床时间、髋关节功能恢复结果、住院时间进行观察比较。 结果：两组在手术时间、术中失血量比较，差异无统计学意义（P > 0.05），而术后并发症、卧床时间及住院时间相比较，人工股骨头置换组优于内固定组，差异有统计学意义（P < 0.05）。髋关节功能恢复结果在术后1，3，6个月比较，人工股骨头置换组优于内固定组，差异有统计学意义（P < 0.05）。 结论：人工股骨头置换治疗高龄不稳定型股骨转子间骨折患者具有术后恢复好、能早期负重、并发症少等优点。

Femoral head replacement or internal fixation for 45 patients with intertrochanteric fractures

BACKGROUND: Primary aim of treatment of intertrochanteric fractures is to restore the weight loading of patients, let the patient be away from the bed early and reduce complications. Which one is better to treat intertrochanteric fractures by femoral head replacement or internal fixation? OBJECTIVE: To compare the clinical outcomes of femoral head replacement and internal fixation for unstable intertrochanteric fractures. DESIGN, TIME AND SETTING: Clinical retrospective study was performed at Second Department of Bone Joint, First Hospital of Jilin University between January 2004 and August 2008. PARTICIPANTS: Forty-five patients with unstable intertrochanteric fractures were divided into two groups: femoral head replacement (n=20) and internal fixation (n=25). METHODS: With lateral position, modified Gibson incision from posterior-lateral hip was adopted in the femoral head replacement group, and the third generation bone cement technique was used to well fix the bone cement and prosthesis. In the internal fixation group, the patients were at supine position, and lateral approach was used for routine internal fixation. MAIN OUTCOME MEASURES: Surgery duration, blood loss, postoperative complications, bed confine time, hip function rehabilitation and discharging time were compared between two groups. RESULTS: There were no statistical differences in surgery duration and blood loss between two groups (P > 0.05). The bed confine time, discharging time and postoperative complications in femoral head replacement group were superior over internal fixation group (P < 0.05). The hip function rehabilitation in femoral head replacement group was better than internal fixation group (P < 0.05) at postoperatively months 1, 3 and 6. CONCLUSION: Femoral head replacement is a better approach in treating unstable intertrochanteric fractures in elder patients, which allows early weight bearing and has less complications compared with internal fixation.