背景：老年脑梗死偏瘫侧股骨转子间骨折为股骨转子间骨折的一种特殊类型，其手术方式包括髓内固定、钢板固定、关节置换，但孰优孰劣，国内外相关文献少，目前尚无定论。

目的：对比股骨近端联合加压交锁髓内钉(InterTAN)、股骨近端锁定加压钢板和关节置换治疗老年脑梗死偏瘫侧股骨转子间骨折的临床效果。

方法：回顾性分析承德医学院附属医院2010年10月至2017年10月收治的88 例老年脑梗死偏瘫侧股骨转子间骨折患者的临床资料，按治疗方式分为3 组，InterTAN 组24 例，股骨近端锁定加压钢板组35 例，关节置换组29 例行骨水泥型人工股骨头置换。比较3 组患者的手术时间、术中出血量、术前及术后血红蛋白差值、术后卧床时间、术后并发症发生率及术后6，12 个月的髋关节Harris 评分。

结果与结论：①InterTAN 组手术时间短于股骨近端锁定加压钢板组和置换组(P＜0.05)；InterTAN 组术中出血量最少、其次为股骨近端锁定加压钢板组，置换组术中出血量最多，3 组之间差异有显著性意义(P＜0.05)；股骨近端锁定加压钢板组手术前后血红蛋白差值小于InterTAN 组和置换组(P＜0.05)；股骨近端锁定加压钢板组术后卧床时间长于InterTAN 和置换组，差异有显著性意义(P＜0.05)；②置换组术后半年髋关节Harris 评分总分最高，其次为InterTAN 组，股骨近端锁定加压钢板组最低，3 组之间差异有显著性意义(P＜0.05)；股骨近端锁定加压钢板组术后1年髋关节Harris 评分总分小于InterTAN 组和置换组，差异有显著性意义(P＜0.05)；③InterTAN 组、股骨近端锁定加压钢板组和置换组术后并发症发生率分别为21%，34%和21%，3 组之间差异无显著性意义(P＞0.05)；④提示相较于股骨近端锁定加压钢板，InterTAN 和人工股骨头置换(骨水泥型)治疗老年脑梗死偏瘫侧股骨转子间骨折术后卧床时间更短、术后髋关节功能恢复更好，均可作为优先选择；但人工股骨头置换(骨水泥型)短期内髋关节功能恢复较InterTAN 更快。

BACKGROUND:Intertrochanteric fracture of cerebral infarction hemiplegia side in older adults is a special type of intertrochanteric are three surgical treatments:intramedullary fixation，plate fixation，and joint ，there are few related literatures about it，which are inconclusive and controversial.

OBJECTIVE:To compare the clinical efficacy of Intertrochanteric Antegrade Nailing System (InterTAN，Smith & Nephew)，proximal femoral locking compression plate and cemented hemiarthroplasty in the treatment of senile cerebral infarction with hemiplegic intertrochanteric fracture.

METHODS:Clinical data of 88 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction treated in the Affiliated Hospital of Chengde Medical University from October 2010 to October 2017 were retrospectively subjects were divided into three groups according to treatment were 24 patients in the InterTAN group，and 35 patients in the proximal femoral locking compression plate group，and 29 patients in the arthroplasty time，intraoperative blood loss，hemoglobin differences before and after operation，postoperative bed rest time，perioperative complication rate，and Harris score at 6 and 12 months after operation were compared among the three groups.

RESULTS AND CONCLUSION:(1) Operation time was shorter in the InterTAN group than that in the proximal femoral locking compression plate group and the replacement group (P＜0.05).Intraoperative blood loss in the InterTAN group was least，followed by the proximal femoral locking compression plate blood loss in the arthroplasty group was most；the difference was statistically significant (P＜0.05).The difference of hemoglobin before and after the operation was lower in the proximal femoral locking compression plate group than in the InterTAN group and arthroplasty group (P＜0.05).Postoperative bed rest time in the proximal femoral locking compression plate group was significantly longer than that in the InterTAN group and arthroplasty group (P＜0.05).(2) The total Harris score of the hip joint at 6 months in the arthroplasty group was highest，followed by the InterTAN group，and it was lowest in the proximal femoral locking compression plate group；significant differences were found among the three groups (P＜0.05).The total Harris score of the hip joint in the proximal femoral locking compression plate group at 12 months after operation was significant lower than that in the InterTAN group and arthroplasty group (P＜0.05).(3) The incidence of postoperative complications in the InterTAN group，proximal femoral locking compression plate group and replacement group were 21%，34% and 21%，respectively，with no significant difference (P＞0.05).(4) It is concluded that compared with proximal femoral locking compression plate，InterTAN and cemented hemiarthroplasty in the treatment of senile cerebral infarction with hemiplegic intertrochanteric fracture have shorter postoperative bed rest time and better postoperative hip function recovery，which can be used as the preferred ，cemented hemiarthroplasty has a faster recovery of hip function than InterTAN in the short term.

文章来源：《中国骨与关节损伤杂志》 网址: http://www.zggygjsszzzz.cn/qikandaodu/2021/0316/478.html

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