颗粒性植骨在高龄骨质疏松股骨粗隆间骨折动力髋关节螺钉内固定术中的应用

Dynamic hip screws strengthened by particulate bone grafting for elderly patients of femoral intertrochanteric fracture with osteoporosis

目的探讨颗粒性植骨在动力髋关节螺钉(DHS)内固定治疗高龄骨质疏松股骨粗隆间骨折患者中的应用效果。方法对56例EvansⅢ～Ⅳ型高龄骨质疏松股骨粗隆间骨折患者采用DHS治疗,其中采用同种异体颗粒骨植骨26例,非植骨组30例。术后对两组患者进行至少半年以上随访,分析手术时间、术中出血量、骨折愈合时间、末次随访时髋关节功能Harris评分及并发症进行比较。结果所有患者获得6～22个月(平均14个月)的随访,两组手术时间、术中失血量等临床指标比较差异均无统计学意义(P>0.05),但两组骨折愈合时间之间有统计学差异(t=2.441,P<0.05)。术后Harris评分植骨组26例中优15例,良9例,可2例,差0例,优良率92.3%;不植骨组30例中优10例,良15例,可3例,差2例,优良率83.3%,两组之间无统计学差异(x^2=1.026,P>0.05)。并发症情况,植骨组有髋内翻1例,无钢板、螺钉切割拔出、螺钉断裂;不植骨组髋内翻4例,术后螺钉切割拔出1例,钢板、螺钉断裂2例。结论 DHS内固定治疗EvansⅢ～Ⅳ型高龄骨质疏松股骨粗隆间骨折患者时,通过粗隆间骨缺损区颗粒性植骨,提高骨折的早期愈合强度,维持内固定的稳定性,是减少该类患者术后螺钉松动、切割移位、内同定失效、骨折不愈合或畸形愈合的有效方法之一,其手术操作方法简单,临床疗效满意,值得进一步探讨。

Objective To study the application of dynamic hip screws strengthened by particulate bone grafting in treatment of intertrochanteric femoral fracture（IFF） with osteoporosis. Methods 56 elderly patients of Evans Ⅲ~Ⅳ IFF with osteoporosis were treated by dynamic hip screws （DHS）. There were 26 cases in bone grafting group, which adopted particulate cancellous bone allograft; there were 30 cases in non-bone-grafting group, which used DHS internal fixation without bone grafting. All patients were followed up at least half a year or longer. Operation time, blood loss, fracture healing time, Harris score at the last follow-up and complications of the two groups were compared. Results There was no significant differences in operation time and intraoperative blood loss of the two groups（P〉0.05）, but there was significant difference in fracture healing time of the two groups （t=2.441,P〈0.05）. In bone grafting group, 92.3% of the cases were evaluated as fine or good according to postoperative Harris Score. In non-bone-grafting group, fine or good rate was 83.3% according to postoperative Harris Score. There was no significant difference. In bone grafting group, there was one case of coxa vara deformity. In non-bone-grafting group, there were four cases of vara deformity, one case of pulled-out screw, and two cases of broken plate and screw. Conclusions In the treatment of Evans Ⅲ~Ⅳ IFF in senile patients with osteoporosis, by using particulate bone grafting to repaire intertrochanteric bone defects, DHS internal fixation can promote fracture healing, and improve the early healing strength to maintain the stability of the internal fixation. It is one of the effective methods which can reduce incidence of postoperative screw loosening, cutting and shifting, fixation failure, nonunion and malunion. The surgical procedure is simple with satisfying clinical results. DHS with particulate bone grafting is worthy of further investigation.