人工股骨头置换术与动力髋螺钉内固定术治疗老年人股骨粗隆间骨折疗效比较

目的 比较人工股骨头置换术（FHR）和股骨动力髋螺钉内固定术（DHS）治疗高龄不稳定股骨粗隆间骨折的疗效.方法 157例患者按随机数字表法分为两组,FHR组采用双极人工股骨头置换术治疗,DHS组采用动力髋螺钉内固定术,比较两组Harris疗效和手术时间、失血量、下地时间、再手术率和并发症等.结果FHR组优良率83.33％,DHS组优良率73.42％,两组优良率差异有统计学意义（Ridit Z=10.654,P=0.000）;FHR组手术时间、术后Harris评分大于DHS组,失血量和下地时间小于DHS组,差异均有统计学意义（t=16.254,P=0.000;t =25.511,P=0.000;t =20.631,P=0.000;t =26.584,P=0.000）;DHS组共发生并发症15例（18.99％）,再手术率5.13％;FHR组出现并发症3例（3.85％）,再手术率0.00％,两组并发症发生率和再手术率差异有统计学意义（P=0.006）.结论与DHS相比,FHR具有更高的疗效和安全性.

Comparison of the effect of DHS and FHR for femoral neck fractures in elderly patients

Objective To compare the clinical effect of femoral head replacement（FHR） and dynamic hip screwsbipolar（DHS） for femoral neck fractures in elderly patients.Methods 157 cases were randomly divided into the two groups.FHR group was treated by bipolar prosthetic replacement and DHS group was treated by dynamic hip screw fixation.The Harris effect,blood loss,operation time,shimoji time,reoperation rate and complications were com pared between the two groups.Results The excellent rate was 83.33 ％ in FHR group,that was 73.42％ in the DHS group,there was significant difference between two groups（Ridit Z =10.654,P =0.000）.The operation time and Harris score in the FHR group were higher than those in DHS group,the blood loss and shimoji time in FHR group were lower than those in DHS group,the differences were statistically significant （t =16.254,P =0.000 ; t =25.511,P =0.000 ; t =20.631,P =0.000 ; t =26.584,P =0.000）.The incidence rates of complication and reoperation in FHR group were 3.85％,0.00％,which were significantly lower than those in DHS group（18.99％,5.13％） （P =0.006）.Conclusion FHR has significant efficacy and higher security for femoral neck fractures in elderly patients compared with DHS,it is worthy of application in clinical.