防旋髓內釘與關節置換治療高齡不穩定型粗隆間骨折患者的效果及隱性失血比較

王建華+林艷++吳永東++郭鵬程++王有寶+連振剛

[摘要] 目的 比較防旋髓內釘與關節置換治療高齡不穩定型粗隆間骨折患者的效果及隱性失血。 方法 選取2014年10月～2016年10月張家口市第一醫院收治的86例高齡不穩定型粗隆間骨折患者作為研究對象，采用隨機數表法將其分為觀察組（43例）和對照組（43例）。觀察組采用防旋髓內釘治療，對照組采用關節置換治療，比較兩組臨床指標（手術時間、術后引流量及下地負重行走時間）、術后髖關節功能、并發癥發生情況及隱性失血量。 結果 觀察組患者手術時間、術后引流量及下地負重行走時間低于對照組，差異均有統計學意義（P < 0.05）；觀察組患者術后1、3、6個月Harris評分顯著高于對照組，差異有統計學意義（P < 0.05）；觀察組術后并發癥發生率（6.9%，3/43）明顯低于對照組（27.9%，12/43），差異有統計學意義（P < 0.05）；觀察組患者隱性失血量、總失血量顯著低于對照組，差異有統計學意義（P < 0.05）。 結論 防旋髓內釘治療高齡不穩定型粗隆間骨折的效果優于關節置換，術后并發癥少，值得在臨床上推廣應用。

[關鍵詞] 不穩定型粗隆間骨折；防旋髓內釘；關節置換；隱性失血

[中圖分類號] R683.4 [文獻標識碼] A [文章編號] 1673-7210（2017）11（c）-0094-04

Comparison of efficacy and hidden blood loss between anti-rotation intramedullary nail and joint replacement in the treatment of unstable intertrochanteric fractures in elderly patients

WANG Jianhua1 LIN Yan2 WU Yongdong1 GUO Pengcheng1 WANG Youbao1 LIAN Zhengang1

1.The First Department of Orthopaedics， the First Hospital of Zhangjiakou， Hebei Province， Zhangjiakou 075000， China；2.School of Nursing， Zhangjiakou University， Hebei Province， Zhangjiakou 075000， China

[Abstract] Objective To compare the efficacy and hidden blood loss of anti-rotation intramedullary nail and joint replacement in the treatment of unstable intertrochanteric fractures in elderly patients. Methods A total of 86 elderly patients with unstable intertrochanteric fractures in the First Hospital of Zhangjiakou from October 2014 to October 2016 were selected as the research objects and randomly divided into the observation group （43 cases） and the control group （43 cases） by random number table. The observation group was treated with anti-rotation intramedullary nail and the control group was treated with joint replacement. The clinical parameters of the two groups （including the operation time， postoperative drainage volume and walking time under ground load）， postoperative hip function， complications and hidden blood loss were compared between the two groups. Results The operation time， postoperative drainage volume and the walking time under ground load in the observation group were lower than those of control group， with statistically significant differences（P < 0.05）. The scores of Harris in the observation group after operation of 1， 3， 6 months were significantly higher than those of control group， with statistically significant differences （P < 0.05）. The incidence of postoperative complications in the observation group（6.9%， 3/43） was lower than that of control group （27.9%， 12/43）， with statistically significant difference（P < 0.05）. The hidden blood loss and total blood loss in the observation group were significantly lower than those of control group， with statistically significant differences （P < 0.05）. Conclusion The curative effect of anti-rotation intramedullary nail is better than joint replacement in the treatment of unstable intertrochanteric fracture in elderly patients and has less postoperative complications. It is worthy of popularization and promotion.endprint

[Key words] Unstable intertrochanteric fracture； Anti-rotation intramedullary nail； Joint replacement； Hidden blood loss

不穩定型粗隆間骨折是一種常見的骨折類型，多見于中老年人，其發生與外傷、骨質疏松密切相關。近年來，隨著人口老齡化趨勢的加重，該類骨折發生率呈逐年升高趨勢。以往臨床上常采用傳統牽引等保守方法進行治療，雖可避免手術創傷，但易引起泌尿系統感染、下肢深靜脈血栓及墜積性肺炎等并發癥[1]。目前臨床上多采用內固定治療粗隆間骨折，包括髓外固定型（解剖鎖定板、動力髖螺釘）和髓內固定型（股骨近端髓內釘、Gamma釘）。本研究比較防旋髓內釘與關節置換治療高齡不穩定型粗隆間骨折患者的效果及隱性失血情況，旨在探究治療高齡不穩定型粗隆間骨折的有效方法。現報道如下：