老年股骨粗隆间不稳定骨折不同内固定方法的疗效比较

Comparative study of instable intertrochanteric femoral fractures with various kinds of internal fixations

关键词:  老年人  股骨粗隆间骨折  内固定  疗效

Key words:  old people  intertrochanteric femoral fractures  internal fixation  curative effect

摘要:

［目的］比较股骨粗隆间不稳定骨折不同内固定方式的疗效，探讨内固定选择在股骨粗隆间骨折治疗中的意义。［方法］1998年3月~2004年12月在大连医科大学第一临床学院骨科分别接受动力髖螺钉(DHS,A组), Gamma钉(B组), 股骨近端钉(PFN, C组)内固定手术治疗的3组，共56例股骨粗隆间不稳定骨折患者，从切口长度、手术时间、术中出血、术中并发症、术中X线暴露次数、术后引流量、骨折临床愈合时间、术后功能恢复程度、术后并发症等方面比较各组的结果。［结果］与A组相比，B、C组切口小(8.6±2.6)、（8.9±1.9） cm，手术时间短(88±12）、（82±13）min，术中出血(356±250）、（340±213）mL及术后引流量少(53±15）、（50±14）mL，骨折临床愈合时间缩短(10.5±1.8）、（10.4±2.5）周，术后并发症较少（4例，2例），术后功能恢复好(83.9%、83.8%)，但术中X线暴露次数增加(9.9±1.9）、（9.2±1.6）次，差异有显著性意义(P<0.01 )。与C组相比，A，B组的术中并发症较高(6例，8例，P<0.01 )。［结论］治疗老年股骨粗隆间不稳定型骨折，首选PFN内固定；单独应用DHS效果较差。

Abstract:

［Objective］To compare the results obtained using three osteosynthesis systems developed for the surgical treatment of instable fractures of the trochanteric region of the femur.［Methods］From March 1998 to December 2004, 54 cases with intertrochanteric hip fractures were followup. They were treated with the followed three kinds of operations respectively: dynamic hip screw (DHS, group A), Gamma nail (group B), proximal femoral nail(PFN, group C). The data of each group were collected for statistical analysis on the following aspects: the incision length, operative time, blood loss , intraoperative complications, fluoroscopy exposures, drainage, clinical healing time of fracture, post-operative restored functions and complications.［Results］In comparing with group A, group B and C was of shorter incision length(8.6±2.6）、（8.9±1.9）cm,shorter opetative time(88±12）、（82±13）min and clinical healing time(10.5±1.8）、（10.4±2.5）weeks, fewer blood loss（356±250）、（340±213）mL and drainage（53±15）、（50±14）mL, highter incidence of post-operative complications（4 cases，2 cases） and and better restored function(83.9%,83.8%) but more fluoroscopy exposures （9.9±1.9）、（9.2±1.6）times. Group A and B are associated with higher incidence of intraoperative complications compared with group C(6 cases，8 cases). And all the differences were of statistical significance (P<0.01).［Conclusions］For the instable senile intertrochanteric hip fractures, the internal fixation of Gamma nail and PFN are more suitable compared with DHS, and we preferred PFN; but the performance of DHS is not recommended.