徐新清++元占玺

[摘要] 目的 评价双极人工股骨头置换术与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的临床疗效。方法 收集2012年8月—2013年7月应用双极人工股骨头置换术与AO股骨近端髓内钉一抗螺旋刀片内固定治疗股骨转子间骨折患者56例。比较两组在手术时间、切口长度、出血量、住院时间、下地负重时间及Harris功能评分等方面的指标并做比较分析。 结果 两组术后髋关节功能优良率差异无统计学意义（P>0.5）。股骨近端防旋髓内针内固定组手术时间、切口长度均较短，出血量较少，差异有统计学意义（P<0.5），但住院时间、下地负重时间上髋关节置换组优势更明显，差异有统计学意义（P<0.5）。两组术后均未出现髋内翻、压疮、内固定物松动断裂、股骨干股骨颈骨折、深静脉血栓形成、肺部感染等并发症。 结论 两种手术方式均是治疗高龄患者转子间不稳定骨折的有效方法。股骨近端防旋髓内针内固定术治疗老年伴内科基础相关基础疾病的不稳定型股骨转子间骨折，手术时间短，出血量少，术后功能恢复满意，降低手术风险，大大提高患者的生活质量。

[关键词] 股骨转子间骨折；人工股骨头置换；AO股骨近端髓内钉一抗螺旋刀片内固定（PFNA）；老年人

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2015）03（a）-0049-03

Comparison between two methods for treatment of unstable intertrochanteric fractures in elderly patients

XU Xinqing YUAN Zhanxi

Shanxi University of Traditional Chinese Medicine，Taiyuan 030024，China；2.Corresponding author：Yuan Zhanxi，the Vice President of Yangquan coalmine group general hospital，Yangquan 045000，China.

[Abstract] Objective To evaluate a reasonable treatment for unstable intertrochanteric Fractures in the elderly patients by comparing the effects of the bipolar hemiarthroplasty and the proximal femoral nail antirotation（PFNA） fixation. Methods To collect 56 patients of unstable intertrochanter fracture of femur from August 2012 to July 2013，who treated with bipolar hemiarthroplasty or PFNA fixation. Comparison was made between the two treated groups in terms of the hospital stays，the length of the incision，the blood loss during the surgery，the duration of the surgical procedure，the time for bed rest postoperatively and Harris hip score. Results The differences in Harris hip score between the two groups were not statistically significant（P> 0.05）. Compared with the PFNA fixation group，the hemiarthroplasty group experienced shorter time of the hospital stay and the bed rest postoperatively，but it had longer incision length，longer operation time，and more blood loss during the surgery .The differences between the two groups were statistically significant （P<0.05）.Neither of the two groups were found coxavara， bedsore， loosening of internal fixation， fracture of femoral shaft or femoral neck， deep vein thrombosis or other complications. Conclusions Both of the two methods are proper treatment methods for the unstable intertroehanterie fractures in the senile patients. PFNA fixation has advantages of shorter operation time，less blood loss and satisfactory functional recovery for unstable intertroehanterie hip fractures in the senile patients， obviously improving the quality of life of patients.endprint

[Key words] Intertrochanteric Fractures；Bipolar hemiarthroplasty；Proximal femoral nail antirotation；Aged

随着我国进入老龄化社会，股骨转子间骨折在老年患者尤其是合并骨质疏松症患者中发生率较高，因而成为股骨转子间骨折的高危人群，且多为粉碎性或不稳定性。有研究表明[1]，手术内固定治疗运用于伴有骨质疏松等各种内科基础疾病的老年患者表现为其对内固定物的把持能力较差，易松动等。但仅采取保守治疗，患者又极易出现坠积性肺炎、泌尿系统感染、褥疮以及栓塞等并发症，而这又是导致该类患者早期死亡的主要原因，即使度过危险期也影响患者日后的生活能力和生存质量。因而选择积极有效的手术方式成为临床关注的重点，该研究回顾性研究运用双极人工股骨头置换术与股骨近端防旋髓内针内固定术（Proximal Femoral Nail-A，PFNA）两种方法治疗56例不稳定股骨转子间骨折的疗效对比，现报道如下。