何健东　　梁笃　　李保林　　曾湘骏　　彭浩

[摘要] 目的 探討高龄不稳定型股骨转子间骨折实施半髋关节置换、防旋型股骨近端髓内钉临床治疗效果比较。方法 随机选取本院2015年3月～2016年1月收治的105例高龄不稳定型股骨转子间骨折患者进行回顾性研究，按入院治疗方式不同分为观察组53例、对照组52例，对照组予半髋关节置换手术，观察组予防旋型股骨近端髓内钉治疗，对两组手术情况、固定术后Harris评分、不良反应进行比较。 结果 两组患者术后1、3、9个月Harris评分比较中观察组术后1个月评分低于对照组，两组差异有统计学意义（P<0.05），术后3、9个月两组评分比较差异无统计学意义（P>0.05），观察组切口长度、手术时间、出血量优于对照组，两组比较差异有统计学意义（P<0.05），两组住院时间比较差异无统计学意义（P>0.05），观察组并发症发生率为11.3%，对照组为3.8%，两组差异有统计学意义（P<0.05）。 结论 临床上针对高龄不稳定型股骨转子间骨折，应当根据患者实际情况，选择半髋关节置换、防旋型股骨近端髓内钉治疗，最终促进患者术后康复。

[关键词] 半髋关节置换；股骨转子间骨折；防旋型股骨近端髓内钉；手术时间；康复

[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2018）17-0067-04

Hemi-hip replacement and anti-rotation proximal femoral intrame-dullary nail for treatment of unstable intertrochanteric fractures in elderly patients

HE Jiandong LIANG Du LI Baolin ZENG Xiangjun PENG Hao

The Sixth Department of Orthopaedics， Guangzhou Zhenggu Hospital， Guangzhou 510045， China

[Abstract] Objective To compare the clinical effects of hemi-hip replacement and anti-rotation proximal femoral intramedullary nail in the treatment of unstable intertrochanteric fractures in elderly patients. Methods 105 elderly patients with unstable intertrochanteric fractures who were admitted in our hospital from March 2015 to January 2016 were randomly selected and retrospectively studied. According to the hospital admission treatment methods， the patients were divided into observation group（n=53） and control group（n=52）. The control group received hemi-hip replacement. The observation group was treated with anti-rotation proximal femoral intramedullary nail. The surgical conditions， Harris score after fixation and adverse reactions were compared between the two groups. Results In the comparison of Harris score between the two groups at 1， 3， and 9 months after surgery， Harris score in the observation group at the 1st month after surgery was lower than that of the control group. There was a statistically significant difference between the two groups（P<0.05）， there was no significant difference in scores between the two groups at 3 and 9 months after surgery（P>0.05）. The incision length， operation time， and bleeding volume in the observation group were better than those in the control group. There was a statistically significant difference between the two groups（P<0.05）. There was no statistically significant difference in the hospitalization time between two groups（P>0.05）. The incidence of complications was 11.3% in the observation group and 3.8% in the control group. There was a statistically significant difference between the two groups（P<0.05）. Conclusion For unstable intertrochanteric fractures in the elderly clinically， the hemi-hip replacement and anti-rotation proximal femoral intramedullary nail should be selected according to the actual conditions of the patients， to promote the patients' postoperative recovery finally.

[Key words] Hemi-hip replacement； Femoral intertrochanteric fracture； Anti-rotation proximal femoral intramedullary nail； Operative time； Rehabilitation

随着我国老龄化社会进程不断加快，导致临床上股骨转子间骨折发病率处于上升阶段，此类疾病主要是由于大小转子间连接位置出现骨折，临床上此类疾病好发于老年患者，同样也是导致患者出现关节功能障碍发生以及死亡的主要原因之一[1]。高龄老人体质以及骨质较差，并且患者骨质疏松，手术治疗后，患者容易出现严重并发症，进而造成患者生命安全威胁。临床治疗中，对于其内固定技术治疗疾病，治疗要求较高，需要根据患者骨折类型以及实际病情选取最佳手术方式，方能提高临床患者治疗疗效，促进患者早日康复[2]。……