人工股骨頭置換與ＤＨＳ內固定對高齡股骨粗隆間粉碎性骨折的治療

[摘要] 目的 比較人工股骨頭置換術與DHS內固定術治療高齡患者粉碎性股骨粗隆間骨折的臨床療效。方法 2006年8月～2007年8月解放軍第一七五醫院骨科收治高齡股骨粗隆間粉碎性骨折患者120例。按Evans分型，Ⅲ型58 例，Ⅳ型62例。所有病例采用完全隨機法分為人工股骨頭置換組與DHS內固定組各60例。結果 所有病例平均隨訪時間1.5年。DHS內固定組有6例手術失敗，重新用人工股骨頭置換術治療，其余均一期治愈；5例發生肺部感染的并發癥。人工股骨頭置換術患者術后僅有2例并發肺部感染，骨折均一期治愈。兩組患者術后平均開始負重時間、住院天數、治愈率、術后并發癥具有統計學差異（P＜0.05或0.001）。結論人工股骨頭置換術治療高齡股骨粗隆間粉碎性骨折患者的療效優于DHS。

[關鍵詞] 高齡； 不穩定性粗隆間骨折； 人工股骨頭置換術； DHS

[中圖分類號] R683.42 [文獻標識碼] A [文章編號] 1673-9701（2009）13-13-03

DHS and Artificial Femoral Head Replacement for Intertrochanteric Fractures in Elderly Patients

PENG Mingdong1 DING Zhenqi2

1.Medical College of Nanchang University，Nanchang 330000；2.Dept of Orthopaedics of The 175th Hospital of PLA，Fujian 363000

[Abstract] ObjectiveTo compare the effects of artificial femoral head replacement and DHS for comminuted intertrochanteric fractures in the elderly. Methods120 patients with comminuted intertrochanteric fractures（included Evans Ⅲ type in 63 cases and Ⅳ type in 57 cases） in the elderly（average age of（78.4±6.7）years）was conducted from August 2006 to August 2008 in our department. 65 patients were male and 55 female. All patients were divided averagely into two groups by completely randomized，60 were treaded with DHS and other half with artificial femoral head replacement. ResultsAll were followed-up average 15 months. six cases of DHS group failed and then dealed with artificial femoral head replacement，and five had postoperative pulmonary infection. Only two case had postoperative pulmonary infection in prosthetic replacement group. The diffferences in postoperative complications，cure rate，hospital stays，begin weight-bearing time between the two groups were of statistical significance（P＜0.05/0.001）. ConclusionThe effect of Artificial femoral head replacement for the management of comminuted intertrochanteric fractures in the elderly is better than that of DHS.

[Key Words]Elderly； Ustable intertrochanteric fractures； Artificial femoral head replacement； DHS

股骨粗隆間骨折是老年人常見的骨折之一，高齡患者目前一般不采用保守治療，但目前對于選用內固定（近幾年國內以DHS應用較多）還是應用人工關節置換術尚存爭議。筆者前瞻性對照研究了DHS內固定術和加長柄骨水泥型人工股骨頭置換術治療高齡粗隆間粉碎性骨折患者120例，認為人工股骨頭置換術可使患者在較短時間內下地活動，減少并發癥，提高患者的生活質量，療效優于DHS。

1 材料與方法

1.1 一般資料

論自2006年8月～2007年8月我科收治高齡股骨粗隆間粉碎性骨折患者120例，其中男65例，女55例；平均（78.4±6.7）歲。103例因摔倒致傷，17例車禍傷；……