3种内固定方法治疗老年股骨粗隆间骨折的病例对照研究

Comparison of three methods of internal fixations for intertrochanteric femoral fractures in elderly patients

目的:比较3种不同内固定方式治疗老年股骨粗隆间骨折的临床疗效。方法:对2004年至2008年筛选的股骨粗隆间骨折患者112例进行回顾性分析,男63例,女49例;年龄60～80岁,平均66.2岁。112例患者分别采用动力髋螺钉(DHS组,40例),股骨近端解剖型钢板(解剖型钢板组,36例)和股骨近端髓内钉(PFN组,36例)3种手术方式治疗。分析比较3组患者手术时间、术中出血量、骨折愈合时间、术后并发症以及髋关节功能评分(Harris评分)。结果:112例患者均获随访,时间20～24个月,平均22.6个月。3组患者手术时间、术中出血量差异无统计学意义,但骨折愈合时间、Harris评分及术后并发症方面差异有统计学意义(P<0.05)。愈合时间:PFN组明显低于其他两组(P=0.001),但DHS组和解剖型钢板组差异无统计学意义。Harris评分:PFN组明显高于其他两组(P=0.001),但DHS组和解剖型钢板组比较则差异无统计学意义。并发症:DHS组出现2例髋内翻,1例内固定松动,1例深静脉血栓;PFN组出现2例下肢深静脉血栓;解剖型钢板组出现2例髋内翻和1例内固定松动,3组比较差异有统计学意义(P=0.001)。结论:股骨粗隆间骨折的治疗应以PFN为首选,适应证广、愈合快,并发症低,效果确切。

Objective：To compare the clinical effects of three methods of internal fixations in treating intertrochanteric fractures in elderly patients. Methods：From 2004 to 2008 ,the clinical data of 112 patients with intertrochanteric fractures were retrospectively analyzed. There were 63 males and 49 females, aged from 60 to 80 years with an average of 66.2 years. The patients were treated respectively with dynamic hip screws （DHS group,40 cases）, anatomic plate （anatomic plate group,36 cases） and proximal femoral intramedullary nails （PFN group, 36 cases）. The data of each group were collected for statistical analysis on the following aspects：operative time, blood loss volume, clinical healing time of fracture, postoperative complica- tions, and hip functional score of Harris. Results： All these patients were followed up from 20 to 24 months with an average of 22.6 months. There was no significant difference in operative time ,blood loss volume among three groups ;there was significant difference in clinical healing time of fracture, Harris score and postoperative complications among three groups （P〈0.05）. In the healing time ,the PFN group was significantly less than that of other groups （P=0.001）,but there was no differences between DHS group and anatomic plate group. In the Harris score, the PFN group was significantly higher than that of other groups （P= 0.001 ）, but there was no differences between DHS group and anatomic plate group. In the aspect of postoperation complica- tion ,there was 2 cases of coxa vara, 1 case of internal fixation loosening and 1 case of deep venous thrombosis in the DHS group ;there were 2 cases of deep venous thrombosis in the PFN group; there were 2 cases of coxa vara and 1 ease of internal fixation loosening in the anatomic plate group （P=0.001）. Conclusion： In the treatment of intertronchanteric fractures, proximal femoral intramedullary nail may be the best choice ,which can decrease healing time as well as complications postoperatively.