两种入路动力髋螺钉治疗老年股骨粗隆间骨折

Treatment of intertrochanteric fracture of femur in senile with dynamic hip screw using different approaches

目的：探讨两种入路动力髋螺钉（DHS）治疗老年股骨粗隆间骨折的疗效.方法：回顾性分析DHS治疗股骨粗隆间骨折78例的临床疗效,其中男33例,女45例;平均年龄76.8岁.采用两种入路方法,入路一：微创DHS内固定22例,男10例,女12例;平均年龄78.3岁;入路二：常规DHS内固定56例,男23例,女33例;平均年龄76.2岁.结果：术中出血量：入路一平均出血92.5 ml,入路二平均出血283.3 ml,采用SPSS 10.0统计学处理软件分析,差异有显著性统计学意义（P＜0.01）.78例中60例（入路一20例,入路二40例）分别获得6个月至4年的随访,平均随访时间15个月.18例失访,其中2例院内死亡,16例电话和信件回访失败.骨折愈合时间：入路一为2.5～4个月,平均3个月;入路二为3～4个月,平均3.6个月,两者差异有显著性统计学意义（P＜0.05）.按照黄公怡等评价标准,入路一：优15例,良2例,差3例,优良率85%;入路二：优23例,良10例,差7例,优良率82.5%,两者差异无显著性意义（P＞0.05）.结论：微创DHS内固定治疗老年股骨粗隆间骨折,与常规DHS内固定术相比具有创伤小、出血少、骨折易愈合、瘢痕小等优点,是值得提倡的一种手术方法。

Objective：To compare clinical effects of intertrochanteric fracture of femur in senile treated with dynamic hip screw （DHS） using two approaches. Methods： From January 2000 to December 2004, 78 patients with intertrochanteric fracture of femur were retrospectively analyzed. Among them, male 33 cases, female 45 cases, the mean age was 76. 8 years old （ range from 60 to 98）. They were treated with DHS using two approaches. Approach 1 （22 cases） was minimal invasive approach, which depends on the technique of the biological fixation,and the mean age was 78.3 years old. Approach 2（56 cases） was common approach（ AO technique） ,and the mean age was 76.2 years old. Results：All the data were analyzed with SSPS 10.0. The average bleeding volume in the operation was 92. 5 ml by approach 1 and 283.3 ml by approach 2 （P 〈0. 01 ）. 60 eases were followed up from 6 months to 4 years after operation. Mean healing time of the fractures was 3 months by appoaeh 1 and 3.6 months by approach 2 （P 〈 0.05 ）. There was no statistical significance in functional evaluation in two approaches（ P 〉 0. 05 ）. Conclusion： Minimal invasive approach with DHS in treatment of intertroehanteric fracture of femur in senile has the advantages of trauma minimally, bleeding less, healing rapidly, and small scar.