人工髋关节置换与股骨近端髓内钉治疗股骨转子间骨折的比较.doc

人工髋关节置换与股骨近端髓内钉治疗股骨转子间骨折的比较 王亚平1，路 通2 (1宜兴市第二人民医院骨科，江苏省宜兴市 214221；2南京医科大学附属无锡人民医院骨科，江苏省无锡市 214023) 文章亮点： 文章的特点为进行人工股骨头置换前，先确定好股骨假体正确的前倾角、偏心距及股骨距长短，并在植入股骨假体后再做转子和股骨距骨性标志的复位固定。该方法具有简单易行，操作及住院时间短、失血量少、患者治疗后可早期下床活动，避免置换后并发症的发生等优点。 关键词： 骨关节植入物；人工假体；股骨转子间骨折；股骨近端髓内钉；人工髋关节置换；植入物；内固定器 主题词： 股骨颈骨折；关节成形术，置换，髋；髋假体；内固定器 摘要 背景：目前，内固定治疗逐渐成为股骨转子间骨折治疗的首选治疗，而内固定置入方法和置入材料种类较多，那么哪种方法临床疗效最好呢？ 目的：对比观察股骨近端髓内钉与人工髋关节置换治疗股骨转子间骨折的疗效。 方法：纳入股骨转子间骨折患者46例，根据自愿选择治疗方式，分别采用股骨近端髓内钉与人工髋关节置换置入治疗转子间骨折。比较两组患者手术时间、术中出血量、Harris评分及X射线检查评估两组患者临床疗效。 结果与结论：46例患者均获得随访，随访时间3-12个月。所有患者均获得骨折愈合。股骨近端髓内钉置入患者切口小于人工髋关节置换患者，但出血量及操作时间均高于人工髋关节置换患者，骨折愈合时间长于人工髋关节置换患者，Harris评分低于人工髋关节置换患者(P 0.05)。提示采用人工髋关节置换治疗股骨转子间骨折创伤小、出血量少，且临床疗效好于股骨近端髓内钉置入患者，但长期疗效如何尚待进一步评估。 Total hip arthroplasty versus proximal femoral nail for intertrochanteric fractures Wang Ya-ping1, Lu Tong2 (1Department of Orthopedics, Second People’s Hospital of Yixing City, Yixing 214221, Jiangsu Province, China; 2Department of Orthopedics, Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China) Abstract BACKGROUND: Internal fixation has become the first choice for the treatment of intertrochanteric fractures. However, the methods and materials for internal fixation are various. Which one has the best clinical efficacy? OBJECTIVE: To compare the effects of proximal femoral nail and total hip arthroplasty for the treatment of intertrochanteric fractures. METHODS: A total of 46 patients with intertrochanteric fractures were voluntarily divided into two groups: proximal femoral nail and total hip arthroplasty. Operation time, intraoperative blood loss, and Harris scores were compared between the two groups, and X-ray examination was used for assessment of clinical efficacy in the two groups. RESULTS AND CONCLUSION: Totally 46 patients were followed-up for 3 to 12 months. Fractures in all the patients were healed. As compared with the total hip arthroplasty group, in the proximal femoral nail group, approach incis