不同方法治疗老年股骨粗隆间骨折的疗效分析

Analyze of the Results of Different Operative Precedures for the Elderly Femoral Intertrochanteric Fractures

目的比较分析应用不同手术方法治疗老年股骨粗隆间骨折的疗效。方法对55例65岁以上股骨粗隆间骨折的患者分别应用股骨近端解剖钢板固定(A组15例)、动力髋螺钉内固定(B组23例)和改良Gamma形髓内钉内固定(C组17例)三种手术方法进行治疗。比较三组手术时间、术中出血量、术后负重时间及随访时Sanders评分结果和并发症发生情况,并进行临床和统计学分析。结果随访5～36个月(平均9个月),三组术式的优良率分别为66.7%、78.5%和94.1%,C组优良率和A组比较差异有显著性意义(P<0.05)。C组与A、B组的手术时间、术中出血量以及术后负重时间比较,差异有统计学意义(P<0.05);三组住院时间、A组与B组在手术时间及术中出血量比较,以及B组与C组优良率比较,差异无显著性意义(P>0.05);A组并发症较高,有髋内翻2例、断钉退钉2例,浅表感染1例,B组和C组并发症主要为大粗隆骨折2例和髋内翻1例。结论老年股骨粗隆间骨折宜采用改良Gamma形髓内钉固定,手术固定牢固,创伤小,负重早,并发症少;对于稳定型骨折且手术承受能力较好的患者,动力髋螺钉固定术后疗效满意。

Objective To compare the clinical results of different operative precedures for the erderly intertroehanteric fractures. Methods 55 cases of over 65 years old with intertrochanteric fractures were operated with three different operative methods ：open reduction and fixation with anatomic plate in 15 cases ,23 patients with dynamic hip screw （DHS） and 17 cases with Gamma nails ;the clinical data such as operation time ,amount of blood loss ,hospitalization time and the time of walking were collected and statistically analyzed. Results All the cases were followed up for 5-36 months （mean 9 months） after operation,the excellent and good rate in A group,B group and C group were 66. 7 %, 78.5 % and 94. 1% respectively, there was signifieant difference between Gamma nail group and anatomic plate group ;in the three groups ,amount of blood loss ,average operation time were statistically different （P 〈0.05）. there is no significant difference in hospitalization time in the three groups. Conclusion Gamma nail comparing with the DHS and anatomic plate is the best internal fixation device for femoral intertrochanterie fractures in the aged people,its advantage is simple manipulation,shorter operative time and clinical healing time,firmer fixation and fewer blood loss ;and DHS for some cases of type A1 fracture is satisfactory also.