切开复位内固定和人工关节置换治疗股骨近端骨折临床疗效.docVIP

切开复位内固定和人工关节置换治疗股骨近端骨折临床疗效 　　doi：10.3969/j.issn.1007-614x.2014.20.41 　　摘 要 目的：比较切开复位内固定和人工关节置换两种手术方法的临床疗效和优缺点。方法：2006年1月-2011年5月收治股骨近端骨折患者65例。将患者分为两组，分别为切开复位内固定组和人工关节置换组，比较两组复位情况、临床效果和长期预后情况。结果：65例股骨近端骨折患者手术均获成功。两组术后药物治疗差异无统计学意义（P0.05）。两种金属植入方式均可缩短病程，达到治疗骨折的目的。但两组也都存在缺陷。结论：临床过程中应该根据患者的自身情况不同采取差异化治疗。 　　关键词 金属植入物 股骨近端骨折 切开复位内固定 人工关节置换 　　The clinical effect and the advantage and the disadvantage of the open reduction and internal fixation and artificial joint replacement in the treatment of proximal femoral fractures 　　Gao Jingbo 　　Department of Emergency，the Peoples Hospital of Puer City，Yunnan 665000 　　Abstract Objective：To compare The clinical effect and the advantage and the disadvantage of the open reduction and internal fixation and artificial joint replacement in the treatment of proximal femoral fractures.Methods：65 case with proximal femoral fractures were selected from January 2006 to May 2011.They were divided into the open reduction and internal fixation group and the artificial joint replacement group.We compared the reduction，clinical effects and long-term prognosis of the two groups.Results：65 cases had been successful.Two groups with postoperative medication had no significant difference（P0.05）.Two kinds of metal implant methods can shorten the course of disease，achieve the purpose of the treatment of fractures.But the two groups also exist defects.Conclusion：We should take different treatment according to the patients own situation in clinical process. 　　Key words Metal implant；Proximal femoral fractures；Open reduction and internal fixation；Artificial joint replacement 　　股骨近端骨折包括股骨头部骨折、股骨颈部骨折以及股骨转子间骨折。本病好发于老年人，常常由于骨质疏松等疾病引起[1]。股骨近端骨折具有较高的致死率，部分患者会出现骨折后1年之内死亡的现象，这与患者需要长期卧床休息后并发的泌尿系统感染、呼吸系统感染以及压疮等疾病相关[2]。单纯的股骨头骨折属于髋关节损伤，易合并髋关节脱位甚至髋臼骨折。当骨折块出现箱内塌陷嵌入关节间且非手术复位治疗失败时，应该立即施行手术治疗。股骨颈骨折为股骨头下部到股骨颈基底之间的骨折，常出现在老年人群中。患者常表现为移动患侧肢体疼痛剧烈，外旋畸形。存在骨折端错位可能的患者应及早主张施行手术治疗。转子间骨折属关节囊外部骨折，基本不会出现股骨头缺血坏死的情况。对于这部分患者采取手术治疗后并发症的情况要较采取保守治疗的患者少且轻。2006年1月-2011年5月收治股骨近端骨折患者65