经皮加压钢板和动力髋螺钉治疗老年股骨转子间骨折的疗效比较

Percutaneous compression plate versus dynamic hip screw in treatment of elderly patients with intertrochanteric hip fractures

目的 比较经皮加压钢板（PCCP）和动力髋螺钉（DHS）治疗老年股骨转子间骨折的疗效.方法 对2007年1月至2010年1月收治的98例老年股骨转子间骨折患者（AO 31.A1-A2）进行回顾性分析,根据内固定方法不同分为PCCP组和DHS组,PCCP组53例,男10例,女43例;平均年龄78.2岁;AO分型：A1型37例,A2型16例.DHS组45例,男7例,女38例;平均年龄75.4岁;AO分型：A1型28例,A2型17例.比较两组患者的手术时间、失血量、骨折愈合时间及末次随访时Harris评分.结果 PCCP组有2例失访,51例患者术后获平均11.6个月（8～24个月）随访;DHS组有3例失访,42例患者术后获平均14.2个月（10～26个月）随访.PCCP组在手术时间、失血量、愈合时间及末次随访时Harris评分明显优于DHS组,差异均有统计学意义（P＜0.05）.两组患者术后均末出现感染、骨不连、钢板螺钉断裂、股骨头螺钉切割、松动移位及股骨头坏死等并发症.结论 与DHS比较,PCCP治疗老年股骨转子间骨折具有手术时间短、切口小、剥离肌肉少、出血少、术后疼痛轻及患者能早期活动等优点.

Objective To investigate the clinical outcomes of minimally invasive treatment of elderly patients with intertrochanteric hip fractures with percutaneous compression plate （PCCP） as compared with dynamic hip screw （DHS） .Methods We randomised 98 patients with intertrochanteric fractures （AO31.A1-A2） to surgical treatment with either the PCCP or DHS and followed them post-operatively from January 2007 to January 2010.There were 53 cases in the PCCP group and 45 in the DHS group.The operation time, blood loss, fracture healing time and the last Harris scores were recorded and compared between the 2 groups.Results In the PCCP group 51 cases obtained a mean follow-up of 11.6 months （range, 8 to 24） and 2 were lost to the follow-up.In the DHS group 42 cases obtained a mean follow-up of 14.2 months （range, 10 to 26） and 3 were lost to the follow-up.Shorter operation time and fracture healing time, less blood loss and higher Harris scores were achieved in the PCCP group than in the DHS group.The differences between the 2 groups were statistically significant （ P 〈 0.05） .Conclusion The minimally invasive PCCP technique can result in a lower blood loss, less post-operative pain, fewer implant-related complications and comparable surgery time than the DHS treatment.