人工全髋关节置换术、动力髋部螺钉内固定术和股骨近端防旋髓内针内固定术治疗高龄不稳定型股骨转子间骨折对比研究

摘要

目的 比较人工关节置换术、动力髋部螺钉(DHS)内固定术和股骨近端防旋髓内针(PFNA)内固定术治疗高龄不稳定型股骨转子间骨折的临床效果.方法 149例不稳定型股骨转子间骨折患者根据手术方式分为人工关节置换术组、DHS内固定组和PFNA内固定组,对3组患者的平均住院时间、手术时间、术中出血量、术后并发症、下床时间、髋关节功能(Harris评分)进行对比.结果 3组患者住院后均在5d内手术,平均住院时间差异无统计学意义(P＞0.05).人工关节置换组和PFNA内固定组的手术时间、术中出血量明显低于DHS内固定组(P＜0.05),而PFNA内固定组与人工关节置换组手术时间差异无统计学意义(P＞0.05),PFNA内固定组术中出血量低于人工关节置换组,差异有统计学意义(P＜0.05).平均下床时间人工关节置换组和PFNA内固定组明显短于DHS内固定组(P＜0.05),而人工关节置换组明显短于PENA内固定组(P＜0.05).人工关节置换组和PFNA内固定组的Harris评分优良率明显高于DHS组,差异有统计学意义(P＜0.05),人工关节置换组和PFNA组的Harris评分优良率差异无统计学意义(P＞0.05).结论 人工关节置换术是治疗老年不稳定型股骨转子间骨折较好的选择.%Objective To compared the clinical effect of artificial hip joint replacement,dynamic hip screw( DHS) internal fixation and proximal femoral nail antirotation( PFNA) internal fixation for the treatment of elderly patients with unstable intertrochanteric fracture. Methods According to operative way,one hundred and forty-nine patients with unstable intertrochanteric fracture were divided into artificial hip joint replacement group, DHS group and PFNA group. The average stay, operation time,postoperative complications,blood loss during operation,the time of out of bed,and hip function( Harris score) were compared among three groups. Results All patients were performed with operation within five days after hospitalization, and there was no significant difference in the average stay among three groups ( P > 0.05). The operation time and blood loss during operation in artificial hip joint replacement group and PFNA group were less than those in DHS group(P <0. 05) ,and the blood loss during operation in PFNA group was less than that in artificial hip joint replacement group(P <0. 05) ,but there was no significant difference in the operation time between PFNA group and artificial hip joint replacement group(P >0. 05). The time of out of bed in artificial hip joint replacement group and PFNA group was significantly shorter than that in DHS group (P<0.05) ,and the time of out of bed in artificial hip joint replacement group was significantly shorter than that in PFNA group (P <0. 05). The fineness rates in artificial hip joint replacement group and PFNA group were significantly higher than those in PFNA group ( P < 0. 05) , but there was no significant difference in the fineness rate between the artificial hip joint replacement group and PFNA group(P > 0. 05 ) . Conclusion Artificial hip replacement is the better choice for the treatment of elderly patients with unstable intertrochanteric fracture.