DHS与带大粗隆柄人工关节置换治疗股骨粗隆间骨折的对比研究
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【摘要】 目的 对比分析DHS螺钉内固定与带大粗隆柄人工关节置换术治疗股骨粗隆间骨折的临床疗效，评价两种手术方法的优劣。方法 60例股骨粗隆间骨折患者，依就诊顺序用随机数字表法分成DHS组(治疗组)30例和带大粗隆柄人工关节置换组(对照组)30例，并对其治疗效果、手术时间、术中出血、术后1年髋关节功能评分进行比较。结果 治疗组32 例，优良率93.33%，对照组30 例，优良率63.33%，差异具有统计学意义(P<0.01)。治疗组在手术时间、术中平均出血量、术后1年Harris评分方面均显着优于对照组，P<0.05。结论 DHS内固定术治疗股骨粗隆间骨折在疗效、手术时间、术中出血量和远期疗效方面明显优于带大粗隆柄人工关节置换。
【关键词】
股骨粗隆间骨折；人工关节置换术；DHS；内固定
The comparative study of DHS and artificial joint Replacement treatment of intertrochanteric fractures
DENG Sheng-li,LIU Xiao-wei. Department of Bone Surgery，The Traditional Medicine Hospital of Hengyangxian， Hengyang 421200,China
【Abstract】 Objective
comparative analysis the clinical curative effect of DHS and artificial joint replacement treatment of intertrochanteric fractures to evaluate two surgical method of the pros and cons. Methods 60 cases of intertrochanteric fracture patients were divided into DHS group(30 cases in treatment group)and artificial joint replacement group of 30 patients(control group), and the treatment effect, operation time, intraoperatie bleeding, 1 year after hip functional were compared. Results The treatment group 30 cases, good rate was 93.33%; the control group, 30 cases, good rate was 66.33%, that showed a significant differences(P<0.01). In treatment group，the operation time, median intra-operative bleeding and postoperative 1 year Harris scoring were significantly better than control group, (P<0.05).Conclusion For intertrochanteric fractures, DHS fixation is obviously better than artificial joint replacement on outcomes, operation time, intra-operative bleeding and long-term follow-up aspects。
【Key words】
Intertrochanteric femoral fracture；Total hip replacement；DHS；Internal fixation
股骨粗隆间骨折作为下肢骨常见、多发的骨折，近年来，其发病率随着人口老龄化及交通的日渐发达而明显增加。内固定器械和治疗方法的进展让手术治疗股骨粗隆间骨折已成为医疗界的共识。动力髋螺钉内固定术(dynamic hip screw，DHS),由滑动加压螺钉发展而来，1970年起在世界范围普遍开展。该钉具有加压和滑动双重功能，允许近端粉碎骨折块压缩，使骨折端自动靠拢得到稳定，可早期活动和负重，后经AO/ASIF系统改进称之为动力髋螺钉(DHS)。带大粗隆柄人工关节置换国外始于40年代，国内始于60年代，是疗效较为肯定的治疗方法，但存在假体松动率较高，容易感染等缺陷。本课题组于2006年1月至2009年7月间对动力髋螺钉内固定术(dynamic hip screw internal fixation, DHS)治疗股骨粗隆间骨折30例进行了观察，并设置了带大粗隆柄人工关节置换术(artificial joint replacement)治疗股骨粗隆间骨折30 例作为对照组，现报告如下。
1 临床资料
纳入患者60例，男26例，女34例；年龄21~75岁 ......
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