人工关节置换术与内固定术治疗老年股骨转子间骨折的效果比较

黄河 宋雪

[摘要]目的 比較人工关节置换术与内固定术治疗老年股骨转子间骨折的效果。方法 选取2017年1～12月我院收治的72例老年股骨转子间骨折患者作为研究对象，采用随机数字表法分为观察组和对照组，每组各36例。观察组患者给予人工关节置换术，对照组患者给予内固定术。比较两组患者的切口长度、术中出血量、手术时间、术后下地时间、术后并发症以及术后12个月的髋关节Harris评分。结果 观察组患者的切口长度、手术时间长于对照组，术中出血量多于对照组，术后下地时间短于对照组，差异均有统计学意义（P<0.05）;观察组患者的术后并发症总发生率低于对照组，差异有统计学意义（P<0.05）;观察组患者术后12个月的疼痛、功能评分及Harris总分均高于对照组，差异有统计学意义（P<0.05）;两组患者的畸形与活动度评分比较，差异无统计学意义（P>0.05）。结论 人工关节置换术在老年股骨转子间骨折患者中的治疗效果显著，术后恢复快，并发症发生率较低，值得临床推广应用。

[关键词]人工关节置换术;内固定术;老年股骨转子间骨折;治疗效果

[中图分类号] R687.4          [文献标识码] A          [文章编号] 1674-4721（2020）3（c）-0075-03

Effect comparison of artificial joint replacement and internal fixation in the treatment of intertrochanteric fracture in the elderly

HUANG He   SONG Xue

Department of Orthopaedics， Pingxiang No.2 People′s Hospital in Jiangxi Province， Pingxiang   337000， China

[Abstract] Objective To compare the effect of artificial joint replacement and internal fixation in the treatment of intertrochanteric fracture in the elderly. Methods A total of 72 elderly patients with femoral intertrochanteric fracture who were treated in our hospital from January to December in 2017 were selected as the research subjects， they were divided into observation group and control group by random number table method， with 36 cases in each group. The patients in the observation group were treated with artificial joint replacement， while the patients in the control group were treated with internal fixation. The incision length， intraoperative hemorrhage， operative time， postoperative time of descent， postoperative complications and the Harris score at 12 months after operation of the two groups were compared. Results The incision length and operation time of the patients in the observation group were longer than those in the control group， the intraoperative hemorrhage was more than that in the control group， and the operation time was shorter than that in the control group， the differences were statistically significant （P<0.05）. The total incidence of postoperative complications in the observation group was lower than that in the control group， the difference was statistically significant （P<0.05）. The pain， function score and Harris total score of the observation group 12 months after operation were higher than those of the control group， the differences were statistically significant （P<0.05）. There were no significant differences in deformity and activity scores between the two groups （P>0.05）. Conclusion The artificial joint replacement is effective in the treatment of intertrochanteric fractures in the elderly， and the postoperative recovery is rapid and the incidence of complications is low. It is worthy of popularizing and applying in clinical practice.

[Key words] Artificial joint replacement; Internal fixation; Intertrochanteric fracture in the elderly; Effect of treatment

股骨转子间骨折是老年人常见的损伤[1-3]，是骨科临床的常见病和多发病，虽然骨折本身所引起的疼痛及肿胀多在伤后或牵引后1～2周内缓解，但由于长时间卧床而并发的呼吸系统、泌尿系统感染，骨质疏松及下肢深静脉血栓形成后造成的心、脑、肺栓塞，均会明显影响疾病预后进而缩短患者的寿命。患者往往健康状况不佳，脏器代偿能力较弱，且常合并多种内科基础疾病，麻醉與手术风险较高，术后并发症发生率明显高于年轻人。股骨转子间骨折的手术方式很多，如钢板螺钉内固定、切开复位动力髋螺钉内固定术、闭合复位股骨近端髓内钉固定，此外还有人工股骨头置换术和人工髋关节置换等手术方式[4-6]。……