人工髋关节置换与股骨近端髓内钉治疗股骨转子间骨折的比较

背景：目前，内固定治疗逐渐成为股骨转子间骨折治疗的首选治疗，而内固定置入方法和置入材料种类较多，那么哪种方法临床疗效最好呢？目的：对比观察股骨近端髓内钉与人工髋关节置换治疗股骨转子间骨折的疗效。方法：纳入股骨转子间骨折患者46例，根据自愿选择治疗方式，分别采用股骨近端髓内钉与人工髋关节置换置入治疗转子间骨折。比较两组患者手术时间、术中出血量、Harris评分及X射线检查评估两组患者临床疗效。结果与结论：46例患者均获得随访，随访时间3-12个月。所有患者均获得骨折愈合。股骨近端髓内钉置入患者切口小于人工髋关节置换患者，但出血量及操作时间均高于人工髋关节置换患者，骨折愈合时间长于人工髋关节置换患者，Harris评分低于人工髋关节置换患者（P〈0.05）。提示采用人工髋关节置换治疗股骨转子间骨折创伤小、出血量少，且临床疗效好于股骨近端髓内钉置入患者，但长期疗效如何尚待进一步评估。

Total hip arthroplasty versus proximal femoral nail for intertrochanteric fractures

BACKGROUND：Internal fixation has become the first choice for the treatment of intertrochanteric fractures. However, the methods and materials for internal fixation are various. Which one has the best clinical efficacy？ OBJECTIVE：To compare the effects of proximal femoral nail and total hip arthroplasty for the treatment of intertrochanteric fractures. METHODS：A total of 46 patients with intertrochanteric fractures were voluntarily divided into two groups：proximal femoral nail and total hip arthroplasty. Operation time, intraoperative blood loss, and Harris scores were compared between the two groups, and X-ray examination was used for assessment of clinical efficacy in the two groups. RESULTS AND CONCLUSION：Total y 46 patients were fol owed-up for 3 to 12 months. Fractures in al the patients were healed. As compared with the total hip arthroplasty group, in the proximal femoral nail group, approach incision was smal er, blood loss was higher, operation time and fracture healing time were longer, and Harris score was lower （P〈0.05）. These findings indicate that the total hip arthroplasty is better than proximal femoral nail for intertrochanteric fractures, with less invasion and blood loss. However, the long-term effects need further studies.