半髋关节置换治疗老年不稳定型股骨粗隆间骨折临床研究

目的探讨半髋关节置换、动力加压钢板内固定（DHS）及PFN治疗高龄老年不稳定型股骨粗隆间骨折的临床疗效,评估半髋关节置换治疗老年不稳定性股骨粗隆间骨折的效果及安全性。方法回顾性分析四川省内江市中医医院2006年1月～2012年1月手术治疗的122例老年不稳定性股骨粗隆间骨折患者的临床资料,按患者手术方法进行分组,其中行半髋关节置换组46例,动力髋螺钉固定组（DHS）39例,股骨近端髓内钉固定组（PFN）37例,比较各组患者术中情况、并发症发生情况及术后关节功能恢复情况。结果半髋关节置换组、DHS及PFN组术中出血量分别是（270.4±34.2）、（184.2±28.6）mL和（196.5±31.6）mL,半髋关节置换组术中出血量高于DHS及PFN组（P〈0.05）。三组患者手术时间比较,差异无统计学意义（P〉0.05）。半髋关节置换组、DHS及PFN组手术时间分别为（76.4±11.2）、（62.9±14.6）min和（80.2±13.1）min,术后卧床时间分别为（3.2±1.6）、（22.6±3.9）d和（21.2±4.0）d,关节负重时间分别为（8.9±2.6）、（30.4±6.2）d和（28.6±5.4）d,半髋关节置换组术后患者卧床时间、关节负重时间短于DHS和PFN组（P〈0.05）,半髋关节置换组、DHS及PFN组植入物相关并发症发生率分别为6.5%、20.5%和18.9%,非植入物相关并发症发生率分别为10.9%、35.9%和40.5%,半髋关节置换组术后非植入物相关并发症及植入物相关并发症低于DHS和PFN组（P〈0.05）,半髋关节置换组、DHS及PFN组术后12个月髋关节评分别是（22.6±2.4）、（18.1±2.6）分和（17.8±2.9）分,术后12个月髋关节评分高于DHS和PFN组（P〈0.05）。结论半髋关节置换治疗老年不稳定性股骨粗隆间骨折能够促进患者术后恢复,减少并发症的发生,提高围术期安全,促进关节功能恢复。

Clinical research of hemiarthroplasty on unstable intertrochanteric hip fractures in senile patients

Objective To investigate the clinical curative effect of hemiarthroplasty,DHS and PFN on unstable in tertrochanteric hip fractures in senile patients and evaluate the safety of hemiarthroplasty on unstable intertrochanteric hip fractures in senile patients.Methods 122 clinical date of intertrochanteric hip fractures in senile patients who were taken operation from January 2006 to January 2012 were analyzed with retrospective analysis,and patients were randomly divided into different groups by operations motheds,including 46 cases in hemiarthroplasty group,39 cases in dynamic hip screw（DHS） group and 37 cases in proximal femoral intramedullary nail（PFN） group,condition in op erations,rate of complications and recovery of joint function were contrasted among there groups.Results Volume of blood loss was（270.4 ±34.2）,（184.2±28.6） mL and（196.5 ±31.6） mL in hemiarthroplasty group,DHS group and PFN group,volume of blood loss was more in hemiarthroplasty group than in DHS group and PFN group（P 0.05）,three groups of patients with operation time,there was no statistically significant difference（P 0.05）.Operation time was（76.4±11.2）,（62.9±14.6） min and（80.2±13.1） min,time of lying in bed was（3.2±1.6）,（22.6±3.9） d and（21.2±4.0） d,time of weight loading was（8.9 ±2.6）,（30.4±6.2） d and（28.6 ±5.4） d in hemiarthroplasty group,DHS group and PFN group,operation time was identical along three groups,time of lying in bed and weight loading was shorter in hemi arthroplasty group than in DHS group and PFN group（P 0.05）,rate of complication correlative with implant was 6.5%,20.5% and 18.9%,rate of complication unrelated with implant was 10.9%,35.9% and 40.5% in hemiarthro plasty group,DHS group and PFN group,rate of complication correlative with implant and unrelated with implant was lower in hemiarthroplasty group than in DHS group and PFN group（P 0.05）,function score of hip joint at 12 months after operations,was（22.6±2.4）,（18.1±2.6） scores and（17.8±2.9） scores in hemiarthroplasty groups,DHS groups and PFN group,function score of hip joint was hgher in hemiarthroplasty group than in DHS group and PFN group at 12 months after operations（P 0.05）.Conclusion Hemiarthroplasty can promote postoperative recovery on unstable in tertrochanteric hip fractures in senile patients,decrease complication,increase safety in perioperative period and im prove recovery of joint function.