高龄转子间骨折半髋关节置换钢丝捆扎方式探讨

目的探讨人工半髋关节置换术分别联合交叉双环钢丝捆扎和普通环形钢丝捆扎联合关节置换术治疗高龄股骨转子间骨折的临床疗效。 方法选择2013年1月至2017年3月在广州市增城区新塘医院就诊的高龄股骨转子间骨折患者114例作为研究对象。年龄≥75岁、Evans分型Ⅲ型或Ⅳ型的非病理性骨折患者纳入研究，排除病理性骨折、合并重要脏器功能障碍、严重关节炎及神经退行性疾病等。采用随机数字表法将患者分为A组和B组。2组患者均采用人工半髋关节置换术，A组采用常规钢丝捆扎法重建大转子，B组采用交叉双环钢丝捆扎法重建股骨大转子。观察2组手术时间、术中出血量、首次下床行走时间、术后住院时间、术后1月、6月、12月髋关节Harris评分和术后并发症发生率。计量资料采用t检验，组间不同时间点分析采用重复测量数据方差分析，计数资料采用卡方检验。 结果两组手术时间、术中失血量、术后引流量相比较差异均无统计学意义(t＝－0.397、0.943、－0.501，P>0.05)；B组术后行走时间、住院时间与A组相比较均显著降低(t＝2.152、2.433，P<0.05)。B组术后1月、术后6月、术后12月时Harris评分与A组相比较均显著升高(t ＝－2.267、－2.396、－2.554，P<0.05)。B组1年内并发症发生率低于A组(χ²＝0.028，P<0.05)。 结论人工半髋关节置换中采用交叉双环钢丝捆扎重建股骨大转子有利于患者早期功能煅炼，可改善患者术后髋关节功能，减少术后并发症发生，值得进一步研究探讨。

Investigation on wire binding methods for hemihip replacement of intertrochanteric fracture in elderly patients

Objective To explore the effect of artificial hemiarthroplasty combined with cross double ring wire binding and common ring wire binding in the treatment of elderly intertrochanteric fracture.Methods A total of 114 elderly patients with intertrochanteric fracture were selected in Xintang hospital of Zengcheng District from January 2013 to March 2017. The patients of age≥75 years old,Evans type Ⅲ or Ⅳnon pathological fractures were included,while the patients of pathologic fractures,severe organ dysfuctions,severe osteoarthritis and neurodegenerative diseases were excluded. The patients were randomly divided into group A and group B with 57 patients in each group. The patients were all treated by artificial hemiarthroplasty. The greater trochanter was reconstructed by conventional wire binding in group A,while it was reconstructed by cross double ring wire binding in group B. The operation time,the amount of bleeding in the operation,the time of first step out of bed,the time of postoperative hospitalization,the Harris scores at one month,three months and six months after operation and the incidence of postoperative complications were observed. The t test was used for measurement data,repeated measurement data variance were used for analysis of different time points between groups,chi-square test was used for counting data. Results There was no significant difference in operation time,the amount of blood loss during the operation and the flow rate after operation between two groups( t =-0. 397,0. 943,-0. 501,P > 0. 05). The time of walking and the time of hospitalization in group B were significantly lower than that in group A( t = 2. 152,2. 433,P <0. 05). The Harris scores of the group B at one months,six months and 12 months were significantly higher than those of the group B( t =-2. 267,-2. 396 and-2. 554,P < 0. 05). The incidence of complications in one year of group B was lower than that in group A( χ^2= 0. 028,P < 0. 05). Conclusion The artificial hemiarthroplasty combined with cross double ring wire binding in the treatment of elderly intertrochanteric fracture is beneficial to the early function exercising of the patients,and can improve the function of the hip joint and reduce the postoperative complications,which is worthy of further study.