两种术式治疗高龄股骨粗隆间骨折的临床研究

目的：比较加长柄股骨头置换与股骨近端髓内钉（PFN）治疗高龄股骨粗隆间骨折的疗效。方法：选取在我院行手术治疗的高龄股骨粗隆间骨折病人113倒作为研究对象，加长柄股骨头置换组（置换组）58例和PFN组55例，对比分析2组病人的临床疗效及并发症等相关指标。结果：PFN纽失血量为（201．5±38．5）ml，住院时间为（6．8±1．9）d，置换组失血量为（863．0±87．2）mL，住院时间为（16．5±4．8）d，经t检验，差异有统计学意义，P〈0．05；PFN组输血率为31．0％，置换组为12．7％，经X2检验，差异有统计学意义，P〈O．05；PFN组末次Harris评分为（84．6±8．5）分，置换组为（89．5±7．2）分，经t检验，差异无统计学意义，P〉0．05；置换组优良率为70．7％，PFN组优良率为78．2％，经X2检验，差异无统计学意义，P〉O．05；置换组并发症总发生率为15．5％，PFN组为7．3％，经X2检验，差异有统计学意义，P〈0．05。结论：两种术式治疗高龄股骨粗隆间骨折的临床疗效均较好．但PFN内固定法术后并发症发生率低于置换组，较适合治疗高龄股骨粗隆间骨折。

THE CLINICAL RESEARCH ON TWO KINDS OF SURGICAL TREAMENT OF SENILE INTERTROCHANTERIC FRACTURES

Objective ：To compare the effect of long-stem femoral head replacement and proximal femoral intramedullary nail （ PFN ） for treatment of osteoporotic intertrochanteric fractures in elderly patients. Methods： 113 cases of intertrochanteric fractures in elderly patients treated in our hospital were studied. 58 cases were treated with long-stem femoral head（ replacement group）, while 55 cases were treated with PFN （PFN group）. The two treatment groups were compared with regard to clinical curative effect and complications. Results：In PFN group, blood loss was （201.5±38.5）ml and hospital stay was （ 6.8±1.9 ） d. In replacement group, blood loss was （ 863.0±87.2 ） ml, and hospital stay was （ 16.5±4.8 ） d. There was significant difference between two groups by t-test （ P〈0.05 ）. Blood transfusion rate in PFN group was 31% , while replacement group was 12.7%. There was significant difference by ehi-square test（P〈0.05 ）. In PFN group,the last Harris score was（ 84.6±8, 5 ）points, while replacement group was （89.5±7.2 ） points. There was no significant difference between two groups（P〉0.05）. The excellent rate in PFN group and replacement group were 78.2% and 70.7% , respectively. The occurrence rate of complications were 7.3% and 15.5%, respectively. There was significant difference between two groups（P〈O. 05 ）by chi-square test. Conclusion： The treatment of osteoporotic intertrochanteric fractures in elderly patients by long-stem femoral head replacement and PFN are both good. But the incidence of complications of PFN fixation is lower than that of replacement group. It is more suitable for treatment of senile intertrochanteric fracture.