手术治疗股骨转子间骨折316例的疗效分析

Analysis of operation methods for 316 cases of intertrochanteric bone fractures

目的比较动力髋螺钉(DHS)、股骨近端解剖型锁定板、股骨近端防旋髓内钉(PFNA)、人工关节置换术治疗股骨转子间骨折的疗效。方法将1997年8月～2012年6月收治的316例患者按照治疗方法分为DHS组(129例)、锁定钢板组(134例)、PFNA组(48例)和关节置换组(5例)。对患者的资料进行同顾性分析。比较前3组患者术前情况、术后负重时间、骨折愈合时间、患髋功能及并发症等。结果患者术后获得7～22个月随访,平均12个月。DHS组、锁定钢板组、PFNA组骨折愈合时间,差异无统计学意义(P>0.05)。Harris评分结果:关节置换组评分最高,为(91.7±13.1)分,与其他3组比较,差异有统计学意义(P<0.05)。PFNA组在切口长度、术中出血量优于其他组,差异有统计学意义(P<0.05)。结论对于稳定性骨折,内固定选择多样。对于不稳定骨折或严重骨质疏松骨折且不能耐受关节置换术者,髓内固定为首选。对于高龄不稳定骨折、严重骨质疏松、术前可行走、能耐受手术的患者,人工双极股骨头置换可作为一种有效的补充手段。

Objective To compare the effect of healing intertrochanteric bone fracture by dynamic hip screw （DHS）, anatomic proximal femoral locking plate,proximal femoral nail anti-rotation （PFNA） and artificial joint replacement. Methods 316 cases of patients,who were treated from August 1997 to June 2012,they were divided into DHS group （129 cases）,locking plate group （134 cases）,PFNA group （48 cases） and artificial joint replacement group （5 cases） ac- cording to the treatment methods.Retrospective analysis was carried out.Pre-operation conditions,post-operation weight-bearing time,symphysis time,hip function and complications were compared. Results Patients were followed up 7 to 22 months （average 12 months）.There were no statistic differentiation in healing time among the DHS group,lock- ing plate group,PFNA group （P 〉 0.05）.Artificial joint replacement group got the highest Harris score （91.7_＋13.1）, and there were significant statistic differentiations comparing to other three groups （P 〈 0.05）.PFNA group had better length of incision and inoperative bleeding than other groups,and there were significant statistic differentiations （P 〈 0.05）. Conclusion There are a lot of intra-fixation selections for stable fracture.Intramedullary fixation would be the best choice for unstable fracture or severe osteoporotic fracture with intolerant artificial joint replacement.Artificial bipolar joint replacement would be an effective supplementary method for advance age patients with unstable fracture,severe osteoporotic fracture and who can walk pre-operation and tolerate operation.