老年股骨粗隆间骨折不同手术方式的疗效分析

Therapeutic effects of different surgical treatments for femoral intertrochanteric fracture in elderly patients

目的探讨不同手术方法治疗老年股骨粗隆间骨折的疗效。方法分别采用动力髋螺钉固定(A组)、动力髁螺钉固定(B组)、股骨近端髓内钉固定(C组)、人工股骨头置换(D组)4种方式治疗126例老年股骨粗隆间骨折病人,比较4组在手术时间、术中出血、术后部分负重时间、术后并发症及髋关节功能状况等方面的差异。结果随访9～48个月,平均23.9个月。对各组的手术时间进行比较,差异无统计学意义(P>0.05);术中出血量C组较少,与A、B、D组之间比较差异有统计学意义(P<0.05);D组术后负重时间短,并发症少,与A、B、C组比较,差异有统计学意义(P<0.05);对髋关节功能状况进行比较,D组优于A、B、C组(P<0.05)。结论老年股骨粗隆间骨折应根据患者骨折类型和骨质疏松情况选择合理的手术方式,可取得较为满意的疗效。对高龄不稳定型粗隆间骨折合并严重骨质疏松者建议行人工股骨头置换术。

Objective To evaluate the therapeutic effects of different surgical treatments for femoral intertrochanteric fracture in elderly patients.Methods One hundred and twenty-six elderly patients with femoral intertrochantenic fracture were treated with four kinds of operations respectively：dynamic hip screw（group A）,dynamic condylar screw（group B）,proximal femoral nail（group C） and femoral head replacement（group D）.The data of each group were collected for statistical analysis including operative time,blood loss,time for partial weight-bearing after surgery,postoperative restored function and complications.Results All cases were followed up for average 23.9 months（9-48 months）.The differences of operative time among all groups were of no statistical significance（P 0.05）.There existed statistical difference of blood loss between group A,B,D and group C（P 0.05） and those in group C were smaller.There were statistical differences of the time for partial weight-bearing after surgery and postoperative complications between group A,B,C and group D（P 0.05） and the results of group D showed shorter time for partial weight-bearing after surgery and less post-operative complications.The differences of postoperative restored function between group A,B,C and group D were of statistical significance（P 0.05） and the effect of group D was more satisfactory.Conclusions Surgical treatments based on good understanding of classification and consideration of osteoporotic condition could improve therapeutic effects for femoral intertrochanteric fracture in elderly patients.Femoral head replacement is good for senile patients suffered from unstable intertrochanteric fracture combined with severe osteoporosis.