不同方法治疗老年股骨转子间骨折的疗效分析

Analysis of the results of different operative procedures for the elderly femoral intertrochanteric fractures

目的比较3种不同偏心型内固定方法治疗老年股骨转子间骨折的疗效。方法对70例〉65岁股骨转子间骨折患者进行手术治疗,24例采用股骨近端锁定解剖板（A组）,23例采用动力髋螺钉（DHS,B组）,23例采用倒置对侧股骨远端锁定板（C组）。比较3组手术时间、术中出血量、住院时间、术后负重时间及随访时Sanders评分结果和并发症情况。结果术中出血量、住院时间、术后负重时间3组比较差异无统计学意义（P〉0.05）。随访6~36个月,A、B、C组Sanders评分优良率分别为：75.0%、78.2%、91.3%。C组优良率和手术时间与A、B组比较,差异有统计学意义（P〈0.05）。A组髋内翻2例、断钉断板1例;B组髋内翻2例、头钉入口处再骨折1例;C组未出现严重并发症。结论老年股骨转子间骨折采用倒置对侧股骨远端锁定板内固定,优于股骨近端锁定板和DHS,其手术时间短、创伤小、固定牢靠、负重早、并发症少。

Objective To compare the clinical results of three different operative procedures for the elderly intertrochanteric fractures.Methods Over 65 year-old patients from 70 cases were operated with intertrochanteric fractures.Proximal femoral fixation with anatomic plate in 24 cases（Group A）,dynamic hip screw（DHS,Group B） in 23 cases and distal femoral up-down fixation with anatomic plate（Group C） in the rest 23 cases.The clinical data such as operation time,amount of blood loss,hospitalization duration,post-operative walking date,Sanders score results and complications were collected and statistically analyzed.Results In the three groups,amount of blood loss,hospitalization duration,post-operative walking date were no significant different（P0.05）.All cases were followed up for 6~36 months after operation,and the excellent and good rate in group A,group B and group C were 75.0%,78.2% and 91.3% respectively.Compared to Group C,there was significant statistic difference on the excellent and good rate and average operation time in Group A and Group B（P0.05）.There were 2 cases with varus malunion and 1 case with nail breaking and plate breaking in group A.There were 2 cases with varus malunion and 1 case with refracture at portal of head nail in group B.There was no serious complications in group C.Conclusions Distal femoral up-down fixation comparing with the DHS and proximal fixation with anatomic plate is the best internal fixation device for femoral intertrochanteric fractures in the aged people.Its advantage is firmer fixation,shorter operative time,less trauma,fewer complications.