加压空心钉与髓内钉固定治疗高龄股骨转子间骨折的比较分析

Comparison of cannulated compression screws and intramedullary nails in fixation for aged patients with intertrochanteric hip fractures

目的分析比较加压空心钉与髓内钉固定治疗高龄股骨转子间骨折的效果,探讨老年股骨转子间骨折的合理治疗方法。方法回顾性分析1998年1月～2004年12月期间接受加压空心钉或髓内钉固定治疗且有完整资料的123例高龄股骨转子间骨折患者。加压空心钉固定组51例,均为顺行股骨转子间骨折,按Evans分型:Ⅰ型14例,Ⅱ型24例,Ⅲ型10例,Ⅳ型3例。髓内钉固定组72例,其中顺行股骨转子间骨折64例,按Evans分型:Ⅰ型10例,Ⅱ型12例,Ⅲ型28例,Ⅳ型14例;逆行股骨转子间骨折8例。比较两种固定方法在手术时间、术中出血量及输血量、平均住院时间、术中及术后并发症、术后1年功能恢复情况及医疗费用等方面的结果。结果对于高龄顺行股骨转子间骨折患者,与髓内钉固定组相比,加压空心钉固定组手术时间短、术中出血量及输血量少、医疗费用低,两者差异有显著性意义(P<0.05)。但两组在平均住院时间、术中及术后并发症、术后1年功能恢复情况等方面的差异无显著性意义(P>0.05)。结论对Ⅰ、Ⅱ型高龄股骨转子间骨折和高危、全身情况差、骨质疏松症严重的Ⅲ、Ⅳ型骨折患者宜采用加压空心钉固定;对于全身情况尚可、不稳定的Ⅲ、Ⅳ型顺行股骨转子间骨折及逆行股骨转子间骨折以髓内钉固定较为稳妥。

Objective To explore a reasonable treatment for intertrochanteric hip fractures in the aged patients by comparing the fixation effects of cannulated compression screws and intramedullary fixation nails. Methods From January 1998 to December 2004, in our department 123 old patients with intertrochanteric hip fracture were fixed with cannulated compression screws or intmmedullary nails. They were followed up and their complete clinic data kept. According to the Evans classification, of the 51 patients who received treatment with cannulated compression screws for their anterograde intertrochanteric hip fracture, 14 were type Ⅰ, 24 type R, 10 type Ⅲ and three type Ⅳ, while of the 72 patients who received treatment with intramedullary nailing, 10 were type Ⅰ, 12 type Ⅱ, 28 type Ⅲ, 14 type Ⅵ, and eight retrograde intertrochanteric hip fractures. A retrospective comparison was made between the old patients treated with the two different fixation devices in terms of operative time, blood loss, transfusion, average hospitalization time, intraoperative and postoperative complications, functional recovery one year postoperatively and treatment expenses. Results The differences between the two groups in operative time, blood loss, transfusion, treatment expenses were of statistical significance （ P 〈 0. 05） . Compared with the group of intramedullary nailing, the group of cannulated compression screws experienced shorter operative time, less blood loss or transfusion, and fewer treatment expenses. The differences in average hospitalization time, intraoperative and postoperative complications, and functional recovery one year postoperatively were of no statistical significance （ P 〉 0. 05） . Conclusions Cannulated compression screws should be chosen for old patients with anterograde intertrochanteric hip fractures of Evans types Ⅰ ＆ Ⅱ or of Evans types Ⅲ＆ Ⅳ who are at a high risk, in a poor health or severely osteoporotic state. For patients with unstable Evans types Ⅲ ＆ Ⅳ or with retrograde intertrochanteric hip fractures, intramedullary nails are suitable.