老年股骨转子间骨折DHS内固定的两种术式的临床评估

目的比较闭合复位经皮DHS内固定术与开放复位DHS内固定术在治疗老年股骨转子间骨折的七项临床指标,评估两种术式的优劣。方法 2008年1月～2011年7月选择60岁及以上的股骨转子间骨折患者62例,随机分为A组和B组,A组采用闭合复位经皮DHS内固定术式,B组采用切开复位DHS内固定术式。比较两组手术时间,手术切口大小,手术失血量(术中出血量和术后引流量),术前、术后血肌红蛋白的变化值,术后VAS疼痛模拟视觉量表评分的分值,并发症的发生率,疗效的优良率。结果 A组与B组在疗效优良率分别为93.75%与92%(P>0.05),A组手术时间50～80min,平均61min;手术切口长度2～4cm,平均3.1cm;手术失血量50～100ml,平均68ml,术中术后均未输血,术后第1天肌红蛋白增加值300～650ug/L,平均306ug/L;术后12hr加术后24hrVAS(模拟视觉量表评分)分值之和2～4分,平均2.3分,明显优于B组,两组数据经统计学处理有显著性差异(P<0.05)。结论闭合复位经皮DHS内固定术是治疗老年股骨转子间骨折的理想方法,值得地市级医院广泛开展。

Objective To compare seven clinical indexes of closure percutaneous internal DHS fixing of relocation with that of open internal DHS fixing of relocation in treating femoral intertrochanteric fracture of the old, and to valuate the quality of these two fixing. Methods During January 2008 to July 2011,62 femoral intertrochanteric fracture patients of over 60 years old were divided randomly into group A and B, group A were treated with closure percutaneous internal DHS fixing of relocation, while group B with open relocation internal DHS fixing of relocation.Valuation was made by comparing the following indexes,operation time, .size of incision,surgery blood loss,including operative bleeding and postoperative drainage, variation of volume of muscle blood red protein between pre-operation and postoperation, value of VAS, incidence of complications, .rate of good curative effect .Results The rate of good curative effect of group A and B is 93.75% and 92%（P〉0.05）.Operation time of group A ranges from 50 to 80 minutes, average time is 61 minutes, Size of incision ranges from 2 to 4cm, average size is 3.1 cm, volume of operation bleeding ranges from 50 to 100ml, average volume is 68ml. In group A there is no intraoperative blood transfusion nor postoperative blood transfusion, and one day after operation the value of muscle blood red protein increases by 300 to 650ug/L ,average value is 306ug/L, total value of VAS 12 hrs and 24hrs postoperative is 2 to 4 points, average value is 2.3 points. Showing outstanding differences of statistical data of group A and B（P〈0.05）, Effect of group A is obviously superior to that of group B. Conclusion The closure percutaneous internal DHS fixing of relocation is an ideal treatment of femoral intertrochanteric fractures of the old, deserving wide application for municipal hospitals.