微创DHS内固定与传统DHS内固定治疗老年股骨粗隆间骨折比较研究

Comparative Study of Internal Fixation with Minimally Invasive and Traditional Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures in Aged People

目的:对微创动力髋螺钉(dynamic hip screw,DHS)内固定和传统DHS内固定治疗老年股骨粗隆间骨折的效果进行比较。方法:将91例老年股骨粗隆间骨折患者随机分为两组,传统组46例采用传统方式置入内固定物治疗,微创组45例采用微创方式置入内固定物。对两组手术创伤大小、术后并发症、骨折愈合及功能恢复情况进行比较。主要通过考察手术切口长度、出血量、输血量、血红蛋白下降幅度、术后术区肢体肿胀情况、血沉变化等来反映手术创伤大小。结果:两组手术创伤差异有统计学意义,传统组大于微创组(P<0.05)。微创组有2例复位不良,传统组有3例复位不良,两组均无深部血肿发生。传统组围手术期死亡2例,其余患者均顺利出院,获12～30个月随访,平均17.1个月。两组各有1例在随访期间死于其它内科疾病,其余骨折均获愈合。术后平均骨折愈合时间微创组3.6个月,传统组3.8个月。术后1年髋关节功能优良率微创组84.1%,传统组79.1%,两组差异无统计学意义(P>0.05)。结论:微创DHS内固定治疗老年股骨隆间骨折,手术创伤小,有利于围手术期恢复和髋关节功能康复。

Objective:To Compare treatment effect of the intertrochanteric fractures in aged people by respectively using minimally invasive and traditional dynamic hip screw(DHS).Methods:91 aged patients with intertrochanteric fractures were divided into two groups randomLy,i.e.traditional group(n=46) and minimal group(n=45),which treated by traditional and minimally invasive DHS,respectively.To compare the conditions of operative trauma,postoperative complications,fractures union and functional recovery between two groups.The length of operative incision,blood loss,blood transfusion,changes of HB and ESR,intumesce of the postoperative limbs were observed and compared.Results:The operative trauma in minimal group was obviously less than that in traditional group(P<0.05),without deep hematoma in two groups.The incidences of malreduction were 2 cases in mini-invasion group and 3 in traditional group respectively.The patients in traditional group successfully left hospital and were followed up from 12 to 30 months(average of 17.1 months) except two cases died in perioperative period.During follow-up period,there was one case died of morbus internus in two groups respectively,and the others were successful union of fractures.The periods for union of fracture in minimal and traditional groups were 3.6 and 3.8 months,respectively.The good rate of hip joint function assessed in one year after operation were 84.1% and 79.1% in mini-invasion and traditional groups,respectively,the difference between two groups was not significant(P>0.05).Conclusions:The minimally invasive internal fixation with DHS to treat intertrochanteric fractures in aged people is little damage,in favour of perioperative improvement and functional recovery.