DHS、解剖型钢板及髋关节置换治疗老年股骨粗隆间骨折48例临床分析

Effect of DHS, anatomical plate and hip replacement in the treatment of elderly femoral intertrochanteric fractures

目的观察DHS、解剖型钢板及髋关节置换治疗老年股骨粗隆间骨折的疗效,对比三组老年股骨粗隆间骨折患者术后下肢深静脉血栓的发生情况。方法选择我院收治的48例股骨粗隆间骨折患者,根据治疗方式不同分为三组,即DHS组、解剖型钢板组和髋关节置换组,每组各16例。对比三组患者手术时间、术中出血、手术前后Harris功能评分及血糖、甘油三酯、胆固醇、血小板以及D-dimer等情况。结果 DHS组及解剖型钢板组手术时间、术中出血均显著低于关节置换组(P<0.05)。三组术后1周、术后6个月的Harris评分均显著优于术前,差异有统计学意义(P<0.05)。三组患者术后血糖、血小板、D-Dimer与术前对比差异均有统计学意义(P<0.05)。术后DHS组及解剖型钢板组D-Dimer显著低于关节置换组(P<0.05)。结论术后D-Dimer增高可作为下肢深静脉血栓的监测指标,DHS及解剖型钢板患者术后深静脉血栓风险相对髋关节置换患者较低。

Objective To analyse the clinical effect of DHS, anatomical plate and hip replacement in the treatment of elderly femoral intertrochanteric fractures, and to compare the incidence of lower limb deep vein thrombosis. Methods Forty-eight patients with femoral intertrochanteric fractures were selected in our hospital. The patients were divided into three groups according to different ways of treatment： the DHS group （n=16）, anatomical plate group （n=16） and hip replacement group （n=16）, which applied DHS, anatomical plate and hip replacement for treatment, respectively. The operation time, amount of intraoperative bleeding, Harris function score before and after treatment, blood glucose, triglyceride, cholesterol, platelet and D-dimer were compared between the three groups. Results The operation time and amount of intraoperative bleeding in the DHS group and anatomical plate groups were significantly shorter or lower than those in the hip replacement group, P〈0.05. The Harris scores one week and 6 months after treatment were significantly better than those before treatment （P〈0.05）. The blood glucose, platelet, D-Dimer showed statistically significant difference before and after treatment （P〈0.05）. The D-Dimer in the DHS group and anatomical plate group was significantly lower than that in the hip replacement group, P〈0.05. Conclusion Postoperative increase of D-Dimer can be used as the monitoring indicators for lower limb deep vein thrombosis. DHS and anatomical plate result in lower risk of postoperative deep vein thrombosis, compared with hip replacement.