人工股骨头置换及DHS治疗高龄股骨粗隆间骨折.doc

人工股骨头置换及DHS治疗高龄股骨粗隆间骨折 　 作者：薛晓峰 尹芸生 杜玉勇 段园慧 李增慧 【摘要】 目的 通过比较分析人工股骨头置换术与DHS内固定术治疗高龄股骨粗隆间粉碎骨折的疗效及预后，前瞻性评价加长柄骨水泥型人工股骨头置换术治疗高龄股骨粗隆间粉碎骨折的效果。方法 1999年6月至2005年6月间我科收治高龄股骨粗隆间骨折120 例患者，男67 例，女53 例，年龄75～94 岁，平均81.4 岁。120 例分别用人工股骨头置换术与DHS内固定术治疗，其中加长柄骨水泥型人工股骨头置换术50 例，DHS内固定术70 例。骨折类型按Evans分型，Ⅲ型58 例，Ⅳ型62 例。结果 110 例患者得到近期随访，平均随访时间1.5年，10 例DHS内固定患者失访。DHS内固定组有6 例手术失败后，均重新用加长柄骨水泥人工股骨头置换术治疗。加长柄骨水泥人工股骨头置换术50 例，术后随访期间患者仅有1 例并发肺部感染，其余疗效满意。术后并发症两组患者比较差异有显著性意义(P＜0.05)。结论 人工股骨头置换术将成为治疗高龄股骨粗隆间不稳定骨折的主要方法。 【关键词】 高龄 骨质疏松 股骨粗隆间骨折 人工股骨头置换术 DHS 　　DHS Internal Fixation and Prosthetic Replacement for Comminuted Intertrochanteric Fractures in Elderly Patients 　 Abstract：Objective To evaluate curative effects and prognosis of management of comminuted intertrochanteric fractures in the elderly by comparing with the artificial femoral head replacement and DHS internal fixation.Methods 120 consecutive cases of prosthetic replacement and DHS internal fixation for comminuted intertrochanteric fractures in the elderly was conducted from June 1999 to June 2005 in our department.120 cases had average age of 81.4±5.7 years(ranged 75～94 years).67 of 120 cases were male，53 of 120 cases female.70 of 120 cases were done by DHS internal fixation，50 of 120 cases artificial femoral head replacement.The pattern of fractures included Evans Ⅲ type in 58 cases，Ⅳ type in 62 cases.Results Folowedup period was average 15 months in 110 cases.In the 50 cases of prosthetic replacement，there was 1 case operational complications.Other curative effects were satisfying.The differences in postoperational complications between the two groups were of statistical significance(P＜0.05).Conclusion Prosthetic replacement for the management of comminuted intertrochanteric fractures in the elderly will be the main method in the future. Key words：elderly；osteoporosis；comminuted intertrochanteric fractures；prosthetic replacement；DHS 股骨粗隆间骨折是老年人常见的骨折之一，随着我国人口的老龄化，股骨粗隆间骨折的发生率亦呈上升趋势。由于老年患者大部分患有骨质疏松症，多数患者还伴有其他多种内科疾病，给治疗带来一定困难。目前，保守治疗高龄粗隆间粉碎骨折