摘要
目的分析采用人工髋关节置换和内固定治疗复杂股骨转子间骨折的临床资料,评价不同手术方式对于预后的影响。方法收集并观察2008年1月至2011年12月,我院骨科收治70岁以上的股骨转子间骨折病例83例,记录并比较围手术期采用人工髋关节置换和内固定两种不同手术治疗的相关情况。采用MS Excel和SPSS17.0进行数据的收集和处理。计量资料以x+s表示,组间比较采用独立t检验;组内前后比较采用配对t检验。计数资料的组间比较采用常规或校正卡方检验,P<0.05差异有统计学意义。结果83例中置换组45例,男24例,女21例,平均(79.2±7.6)岁,平均手术时间(75.4±18.5)min;平均出血量(320±75.6)ml,平均住院天数(8.9±2.1)天,卧床时间(7.8±2.7)天。内固定组38例,男21例,女17例,平均年龄(78.6±7.3)岁,平均手术时间(71.5±25.6)min;平均出血量(290±65.4)ml,平均住院天数(9.2±2.3)天,卧床时间(9.2±2.3)天。两组比较,尽管置换组出血量和平均手术时间略高于内固定组,两者差异无统计学意义(P>0.05)。置换组卧床时间明显低于内固定组,差异有统计学意义(P<0.05)。术后1、3、6个月Harris评分,两组比较,置换组评分均明显优于内固定组,差异具有统计学意义。结论人工髋关节置换治疗复杂股骨转子间骨折能有效恢复关节功能,早期下地,减少卧床相关并发症,但考虑到手术的复杂性和关节置换可能出现的并发症,须严格掌握适应证,作好置换前的综合评估和准备工作。
Objective To analyze the clinical data of artificial hip replacement and internal fixation for complex femoral intertrochanteric fractures, and to evaluate the effects of different operative methods on the prognosis. Methods The data of 83 patients with femoral intertrochanteric fractures who were adopted and treated from January 2008 to December 2011 were collected and observed, with the age of over 70 years old. The perioperative information of the patients who were treated With artificial hip replacement and internal fixation respectively was recorded and analyzed. The data were collected and processed using the Micro Soft （ MS ） Excel and statistical product and service solutions （ SPSS ） 17.0. The measurement data were recorded as Mean 4- standard deviation （ SD ）. Differences between the 2 groups were compared with the independent-samples t-test, and differences of items in the same group were compared with the paired-samples t-test. The enumeration data between the 2 groups were compared with conventional or updated chi-square tests. When the P value was less than 0.05, the differences were considered to be statistically significant. Results Among the 83 patients, 45 patients were treated with cemented hip arthroplasty, whose average age was （ 79.24-7.6 ） years old, including 24 males and 21 females. The average operation time was （ 75.4~18.5 ） minutes. The mean bleeding volume was （ 3204-75.6 ） ml. The average hospital stay was （ 8.9~2.1 ） days and the average bedridden time was （ 7.84-2.7 ） days. 38 patients were treated with internal fixation, whose average age was （ 78.64-7.3 ） years old, including 21 males and 17 females. The average operation time was （ 71.54-25.6 ） minutes. The mean bleeding volume is （ 2904-65.4 ） ml. The average hospital stay was （ 9.24-2.3 ） days and the average bedridden time was （ 9.2 4-2.3 ） days. Even through the bleeding volume in the group treated with cemented hip arthroplasty was larger than that of the group treated with internal fixation, and the average operation time was longer, there were no statistically significant differences between them. The bedridden time in the group treated with cemented hip arthroplasty was longer than that of the group treated with internal fixation, and there were statistically significant differences between them. When the Harris scores of the 2 groups were compared at 1, 3 and 6 months postoperatively, the group treated with cemented hip arthroplasty was obviously superior to the group treated with internal fixation, and the differences between them were statistically significant. Conclusions Artificial hip replacement for complex femoral intertrochanteric fracRtres can effectively restore the joint function and help the patients leave the sickbed early, with few complications caused by a long-term bed rest. Due to the complexity of the arthroplasty and possible complications, indications should be properly mastered, and preoperative comprehensive assessment and preparation are necessary.
出处
《中国骨与关节杂志》
CAS
2013年第11期627-631,共5页
Chinese Journal of Bone and Joint
关键词
关节成形术
置换
髋
骨折固定术
髓内
骨折
股骨骨折
髋关节
Arthroplasty, replacement, hip
Fracture fixation, intramedullary
Fractures, bone
Femoralfractures
Hip joint
