DHS和人工股骨头置换治疗高龄合并骨质疏松不稳定股骨粗隆间骨折的疗效分析

目的通过比较动力髋螺钉和双极人工股骨头置换术治疗老年骨质疏松性股骨粗隆间骨折的疗效,探讨老年骨质疏松性股骨粗隆间骨折合理的治疗方法。方法选取人工关节置换治疗老年股骨粗隆间骨折29例(HA组),随访2年1个月至4年2个月,平均3年1个月,同期行动力髋螺钉手术(DHS组)30例,随访2年1个月至4年5个月,平均3年3个月。比较2组患者的手术时间、手术出血量、输血量、术后部分负重时间,术后并发症,和末次随访的Harris评分。结果两组患者均安全度过围手术期,患者的术后并发症,手术时间、出血量,输血量及末次随访的Harris评分比较差异无显著性(P>0.05),HA组在骨质疏松程度、术后部分负重时间上与DHS组有显著性差异(P<0.05)。结论老年股骨粗隆间骨折应根据骨折类型和骨质疏松程度选择合适的手术治疗方式,对于高龄合并严重骨质疏松的不稳定股骨粗隆间骨折采用人工股骨头置换术可取得良好效果。

Effect Analysis of DHS and Artificial Femoral Head Replacement in Treatment of Unstable Osteoporostic Intertrochanteric Hip Fractures in Elderly Patients

Objective To compare the clinical effect of dynamic hip screw (DHS) and bipolar artificial femoral head replacement (HA) for senile interochanteric femoral fractures, and explore the reasonable treatment of osteoporotic intertrochanteric fractures. Methods 29 cases of elderly femoral intertrochanteric fracture treated with artificial joint replacement (HA group) were followed up for 2 years 1 month to 4 years 2 months (average of 3 years 1 month). 30 cases at the same period treated with DHS (DHS group) were followed up for 2 years 1 month to 4 years 5 months (average of 3 years 3 months). The operative time, blood loss, blood transfusion, postoperative partial weight-bearing time, postoperative complications, and the Harris score of last follow-up of the two groups were compared. Results All patients were safe in perioperative period. The difference of postoperative complications, operative time, bleeding, blood transfusion and the Harris score of last follow-up between the two groups had no statistical significance (P >0.05), while the difference of osteoporosis degree and postoperative partial weight-bearing time between the two groups had statistical significance (P <0.05). Conclusions The appropriate surgical treatment for elderly patients with intertrochanteric fractures should be selected according to the fracture type and osteoporosis degree. Hemiarthroplasty for elderly patients with severe osteoporosis unstable intertrochanteric fracture can achieve desirable results.