MIDHS和CDHS治疗老年股骨转子间稳定骨折疗效分析

Analysis of the results of MIDHS and CDHS for intertrochanteric stable fractures in aged patients

目的对比微创动力髋螺钉(minimally invasive dynamic hip screws,MIDHS)和常规动力髋螺钉(commondynamic hip screws,CDHS)治疗老年股骨转子间稳定骨折的疗效。方法回顾性分析2005年6月～2009年5月,用MIDHS(33例)和CDHS(30例)治疗老年股骨转子间稳定骨折63例的临床资料。结果 63例获得8～25(平均21.2)个月的随访。术中平均出血量MIDHS:(81.21±19.49)ml,CDHS:(326.67±63.97)m1;平均手术时间MIDHS:(59.55±20.54)min,CDHS:(106.67±28.48)min;骨折平均愈合时间MIDHS:(16.80±1.56)周,CDHS:(17.83±1.84)周;差异有统计学意义(P<0.01)。术后髋关节功能按Kudema改良Merle D'Aubigne与Postel评分法,优良率MIDHS:87.9%,CDHS:86.7%,两者差异无显著性意义(P>0.05)。结论 DHS是治疗老年股骨转子间骨折的有效方法。与CDHS内固定术相比,MIDHS具有创伤小、出血少、骨折易愈合、瘢痕小等优点。

Objective To compare the clinical effects of minimally invasive dynamic hip screws （MIDHS） and com- mon dynamic hip screws（CDHS） （ AO technique） in treating aged intertmehantefic stable fractures. Methods From June 2005 to May 2009,63 patients with intertroehantefic stable fractures were treated with MIDHS （33 cases） or CDHS （30 case） were retrospectively analyzed. Results 63 cases were followed up from 8 - 25 （ 21.2 ） months after operation. The average blood loss in the operation was （81.21 ± 19.49） ml by MIDHS and （326.67 ± 63.97 ） ml by CDHS（ P 〈 0.01 ）. The aver- age operation time of MIDHS was （59.55± 20.54） minutes and CDHS was （106.67 ± 28.48 ） minutes （P 〈 0.01 ）. Mean healing time of the fractures was （ 16.80 ± 1.56） weeks by MIDHS and （ 17.83± 1.84） weeks by CDHS （ P 〈 0.01 ）. These patients were assessed to hip function according to Kuderna modified Merle D＇Aubigne and Postel scor,the rates of excellent and good was 87.9% in MIDHS group,86.7% in CDHS group. There was no statistical significance in functional evaluation in two approaches （ P 〉 0.05 ）. Conclusion Internal fixation of DHS possesses good therapeutic effect for treating femoral in- tertroehanteric fracture cases of Evans type Ⅰ or type Ⅱ. MIDHS in treatment of intertrochanterie fracture of femur in senile has the advantages of trauma minimally, bleeding less, healing rapidly, and small seal.