摘要
目的:对比观察动力髋螺钉内固定与带大转子柄的人工关节置换术治疗高龄股骨转子间骨折的临床疗效,评价人工关节置换术治疗高龄股骨转子间骨折的效果。方法:对1999-09/2004-06西安市红十字会医院收治的156例高龄(65岁以上)股骨转子间骨折患者行手术治疗,其中男93例,女63例;年龄65～87岁,平均(72.7±10.6)岁;左侧102例,右侧54例;骨折类型:Evans-JensenⅠ型49例,Ⅱ型64例,Ⅲ型43例。根据手术方式的不同,将患者随机分成关节置换组76例,采用带大转子柄的人工关节置换术治疗,内固定组80例,采用切开复位,动力髋螺钉内固定术治疗。对两组患者的基本情况、手术时间、失血量、总输血量、并发症、下地时间及患肢功能等进行统计学分析。结果:参加实验156例患者,关节置换组1例、内固定组2例失访,其余病例均获X射线及临床随访,随访率98.1%,随访期间关节置换组1例死于脑血管意外,1例死于心肌梗死,内固定组1例死于坠积性肺炎,1例死于脑血管意外,1例猝死原因不明。两组患者在失血量、总输血量及手术时间上经统计学分析差异无显著性意义(P>0.05)。而在术后并发症、下地时间及患肢功能(优良率)等方面均表现出明显的统计学差异[4,12例;(8.6±3.6),(73.6±11.8)d;89.5%,77.5%,(P<0.05)];最终随访时髋关节的harris’评分关节置换组和内固定组分别为(84.6±7.4)和(81.3±5.6)分,经统计学分析,差异有显著性意义(P<0.05)。结论:带大转子柄的人工关节置换术治疗老年人股骨转子间骨折具有卧床时间短,术后恢复快,并发症少,功能恢复好等优点,较动力髋螺钉固定有一定优势。
AIM： To comparatively observe the clinical effects of hip joint replacement and dynamic hip screws （DHS） in treating senile intertrochanteric fractures, and evaluate the effect of hip joint replacement in treating senile intertrochanteric fractures. METHODS： From September 1999 to June 2004, 156 elderly patients with intertrochanteric fracture （93 males and 63 females） with an average age of 72.7 years ranged from 65 to 87 years, were treated with DHS or hip joint replacement. The fracture was on the left in 102 cases and on the right in 49 cases. The types of fracture were Evans-Jensen type Ⅰ in 49 cases, type Ⅱ in 64 cases and type Ⅲ in 43 cases. The patients were randomly divided into hip joint replacement group （n=76） and DHS group （n=80）. The general information, operative duration, intraoperative blood loss, total volume of blood transfusion, complications, walking time and function of affected limb were statistically analyzed in the two groups.
RESULTS： A total of 156 patients participated in the study, 1 case in the hip joint replacement group and 2 cases in the DHS group lost to the follow-up, all the other patients received the radiography and clinical follow-up, the follow-up rate was 98.1%. During the follow-up, 1 case died from cerebrovascular accident and 1 case died of myocardial infarction in the hip joint replacement group; 1 case died of hypostatic pneumonia, 1 case died of cerebrovascular accident and 1 case died from unknown reason in the DHS group. The intraoperative blood loss and total volume of blood transfusion had no significant difference between the two groups, but the postoperative complications, walking time and function of affected limb （excellent rate） were significantly different [4, 12 cases; （8.6±3.6）, （73.6±11.8） days; 89.5%, 77.5%, P 〈 0.05]. The hirris score of hip joint at final follow-up was significantly different between the hip joint replacement group and DHS group [（84.6±7.4）, （81.3±5.6）, P 〈 0.05]. CONCLUSION： Hip joint replacement in treating senile intertrochanteric fractures has the excellence of short time in bed, quick healing and fewer complications. It is worth to be introduced.
出处
《中国临床康复》
CSCD
北大核心
2006年第4期36-38,共3页
Chinese Journal of Clinical Rehabilitation
