老年股骨粗隆间骨折不同内固定治疗疗效观察

Clinical effects of different surgical treatments for femoral intertrochanturic fractures

目的探讨不同手术方式治疗老年股骨粗隆间骨折的临床效果。方法回顾分析181例老年股骨粗隆间骨折,按AO分型:A1型98例,A2型60例,A3型23例。采用动力髋螺钉(DHS)92例,解剖型钢板50例,空心螺纹钉8例,髓内钉固定31例。结果随访163例,其中A1型88例,A2型52例,A3型23例。按患者所采用内固定方式分类:动力髋螺钉(DHS)固定88例,解剖型钢板49例,经皮空心螺钉3例,髓内钉固定23例。治疗结果根据黄公怡标准评定,动力髋螺钉(DHS)固定优良率97.7%;解剖型钢板固定优良率93.9%;空心螺纹钉100%,髓内钉(PFN)固定优良率100%,总优良率96.9%。结论根据粗隆间骨折分类,采取不同手术内固定方式治疗可以提高老年人股骨粗隆间骨折的治疗效果,并且明显减少并发症。动力髋螺钉(DHS)及解剖型钢板是治疗老年股骨粗隆间骨折较好的方法,对于反向斜行粗隆间骨折我们主张用髓内钉固定(PFN),PFN较其他内固定侵袭性小,操作简便,手术时间短。骨折线位良好者可采用经皮空心螺纹钉。

Objective To investigate the clinical effects of different surgical treatments for femoral intertrochanturic fractures.Methods Atotal of 181 patinets with femoral intertrochanteric fractures,according to AO classification： 98type 1,60type 2,23type 3.One of the use of dynamic hip screw（DHS）92 cases,50 case of anatomic plate,hollow screw 8 cases,proximal femoral nail（PFN）31 cases.Results Follow-up results of 163 cases,of which 88 cases of type 1,2-type 52 cases,3-type 23 cases.A fixed way of classilitcation dynamic hip screw（DHS） fixation in 88 cases,49 cases of anatomic plate,hollow screw 3 cases,proximal femoral nail（PFN） 23 cases.According to Huang gong yi criteria,dynamic hip screw（DHS） a fixed rate of 97.7% excellent;anatomic plate fixed of 93.9% excellent;hollow screw 100%,proximal femoral nail（PFN） 100%,with a total rate of 96.9% excellent.Conclusion According to fracture classificarion,the use of different surgical procedures can improve the femora intertrochanteric fracture better way,for the elderly or those with organic disease may be hollow percutaneous screw.PFN is less invasive,easier to perform and with shorter operation time.