动力髋螺钉与锁定加压接骨板置入内固定治疗高龄老年股骨转子间骨折的效果比较

Curative effect of dynamic hip screw versus locking compression plate on femoral intertrochanteric fractures in senile patients

背景:治疗股骨转子间骨折的内固定有动力髋螺钉、Gamma钉、股骨近端交锁髓内钉等,究竟使用何种内固定目前仍存在争议。目的:比较传统动力髋螺钉与锁定加压接骨板治疗老年股骨转子间骨折临床疗效的差异。方法:2007-06/2010-03收治老年股骨转子间骨折96例,分别采用动力髋螺钉与锁定加压接骨板治疗各48例,两组患者性别、年龄、骨折类型、致伤原因等情况匹配。股骨近端锁定加压接骨板采用00Cr18Ni14Mo3不锈钢、Ti6Al4V钛合金或纯钛,部分钛合金或纯钛产品表面经阳极化处理,非灭菌包装。动力髋螺钉内固定弹性模量接近人体骨,耐体液电解,耐腐蚀强,性质稳定。比较两组患者手术时间、术中出血量、伤口引流量、骨折愈合时间及内固定后髋关节功能恢复情况。结果与结论:与动力髋螺钉组相比,锁定加压接骨板组的手术时间及骨折愈合时间均明显缩短,术中出血量明显减少(P<0.01)。锁定加压接骨板组髋关节功能恢复优良率显著高于动力髋螺钉组(94.6%,87.9%,P<0.01)。提示与传统动力髋螺钉相比,锁定加压接骨板内固定治疗高龄股骨转子间骨折生物力学更合理,操作简便、微创、固定稳固、骨折易愈合,尤其适用于骨质疏松或老年患者。

BACKGROUND：Dynamic hip screw（DHS）,Gamma nail,and femoral proximal interlocking intramedullary nail have been used in internal fixation of femoral intertrochanteric fractures.Which one is better is still controversial.OBJECTIVE：To evaluate the difference between DHS and locking compression plate（LCP） in treating femoral intertrochanteric fractures in the elderly.METHODS：From June 2007 to March 2010,96 cases of senile femoral intertrochanteric fracture treated with DHS（n=48） and LCP（n=48） were selected.The operative time,blood loss,fracture healing time and hip function scores were recorded.RESULTS AND CONCLUSION：Compared with the DHS group,the operation time and fracture healing time was shorter and the volume of blood loss was fewer in the LCP group（P 0.01）.The joint function was better in the LCP group than the DHS group（94.6%,87.9%,P 0.01）.The findings of the study show that LCP is a simple,microinvasive,stable internal fixation treatment with reasonable biomechamical characteristics and rapid fracture healing,especially for osteoporosis or senile patients.