老年患者股骨粗隆间骨折内固定治疗

Different Internal Fixation for Intertrochanteric Fractures in Elderly Patients

目的回顾分析不同内固定方式对老年股骨粗隆间骨折的临床疗效。方法 1999年3月-2009年5月采用内固定手术治疗121例股骨粗隆间骨折患者,根据内固定方式不同分为4组:动力髋螺钉(DHS;A组43例)、经皮加压钢板(PCCP;B组19例)、股骨近端髓内钉(PFN;C组27例)、Gamma钉(D组32例)。4组患者年龄、骨折类型(Tronzo-Evans分型)等一般资料比较差异无统计学意义(P>0.05),具有可比性。记录手术时间、术中出血量及术后引流量、术中术后并发症、骨折临床愈合时间、术后髋关节功能恢复程度,比较评价各组临床疗效。结果术后各组患者切口均Ⅰ期愈合,无伤口感染等早期并发症发生。患者均获随访,随访时间18～108个月,平均56.4个月。与A组比较,B、C、D组手术时间明显缩短,术中出血量及术后引流量减少,骨折愈合时间缩短,差异均有统计学意义(P<0.01),A组较差;B、C、D各组间两两比较差异无统计学意义(P>0.05)。术后并发症发生率A组较高,与其余各组比较差异有统计学意义(P<0.05)。末次随访时各组髋关节功能Harris评分比较差异无统计学意义(P>0.05)。结论 B、D组及C组3种手术方法在治疗老年患者股骨粗隆间骨折具有创伤小、并发症少等优势,与A组法比较更有利于老年患者术后康复,但应注意骨折的良好复位及内固定物位置。

Objective To compare clinical outcomes of four kinds of internal fixation for intertrochanteric fractures in elderly patients.Methods From March 1999 to May 2009,121 elderly patients with intertrochanteric fractures were treated in our hospital.The surgical procedures included dynamic hip screw（DHS,group A,n=43）,percutaneous compression plate（PCCP,group B,n=19）,proximal femoral nail（PFN,group C,n=27） and Gamma nail（group D,n=32）.The difference of patient age and fracture type in the four groups has no statistical significance（P0.05）.The data of operation duration,blood loss,postoperative complications,fracture healing time and postoperative hip function score were used to evaluate the clinical outcome.Results Incisions of patients in all groups were healed without any wound infection.All patients were followed up for 18 to 108 months with an average time of 56.4 months.Group B,C and D had the advantages of shorter operation time,less blood loss,and shorter fracture healing time compared with group A（P0.01）,while there was no statistical difference among groups B,C and D in terms of the above indicators（P0.05）.The rates of postoperative complications were higher in group A than other groups（P0.05）.The postoperative hip function scores were not significantly different among the four groups（P0.05）.Conclusions PPCP,Gamma nail and PFN are suitable for elderly patients with intertrochanteric fractures with slight trauma and fewer complications.The fracture reduction and the position of the internal fixation are important.