摘要
目的探讨动力髋部螺钉(DHS)、股骨近端髓内钉(PFN)和人工股骨头置换术对老年股骨转子间不稳定型骨折的疗效。方法96例股骨转子间不稳定型骨折患者中,DHS组34例,PFN组36例,人工股骨头置换术组26例,对其术中、术后指标进行比较。结果96例患者随访10～38个月,平均18个月。3组术中出血量、手术时间、术后引流量、术后下床时间之间的差异有统计学意义。术后并发症以DHS组最多,PFN组次之,人工股骨头置换组最少。按Harris评分系统评估,各组优良率分别是79.4%(DHS组)、94.2%(PFN组)、92.3%(人工股骨头置换组);后两组的优良率显著高于DHS组(P<0.05)。结论对于老年股骨转子间不稳定型骨折的治疗,PFN和人工股骨头置换两种术式均行之有效,优于DHS,在严格掌握适应证的前提下,人工股骨头置换术后可早期下床行走,减少并发症,对高龄伴严重骨质疏松的患者尤为适宜。
Objective To retrospectively analyze the therapeutic effects of dynamic hip screws （DHS） , proximal femoral nail （PFN） and artificial femoral head replacement to treat elderly patients with unstable intertrochanteric fracture. Methods 96 elderly patients with unstable intertrochanteric fractures were divided to three groups. Among them, 34 cases were fixed with dynamic hip screws （ DHS group） , 36 cases were fixed with proximal femoral nail （ PFN group） , and 26 cases were treated with artificial femoral head replacement. We compared the effect parameters of the three groups during and after operation. Results All patients were followed up for 10 -38 months, mean 18 months. The statistical analysis results showed that there were statistical difference among three groups in the volume of blood loss, operation time, postoperative drainage volume and postoperative activity out of bed days. Compared with the other groups, postoperative complications incidence rate was the highest in the DHS group. It was the lowest in artificial femoral head replacement group among them. According to Harris evaluation standard, the excellent and good rate of DHS group was 79.4% , of PFN group was 94. 2% , and of artificial femoral head replacement group was 921 3%. So, the excellent and good rate of PFN group and artificial femoral head replacement group were all significantly higher than that of DHS group （ P 〈 0. 05 ）. Conclusions The therapeutic effects of PFN and artificial femoral head replacement for the treatment of elderly patients with unstable intertrochanteric fracture were better than that of DHS. While, artificial femoral head replacement, especially suitable for the aged patients with osteoporosis, has advantages of earlier postoperative activity out of bed and fewer postoperative complications, which can improve life quality.
出处
《中华关节外科杂志（电子版）》
CAS
2009年第1期21-24,共4页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
股骨颈骨折
关节成形术
置换
髋
Femoral neck fractures
Arthroplasty, replacement, hip
