股骨转子间骨折手术治疗效果及其影响因素分析

Clinical effect and the influence factors of surgery for treatment of pa- tients with intertrochanteric fractures

目的探讨股骨转子间骨折手术治疗效果及其影响因素，为股骨转子问骨折患者提供更好的治疗方法。方法选取浙江省衢州市柯城区人民医院2010年3月～2012年3月收治入院的60例股骨转子间骨折患者并按照数字随机方法分为两组：其中滑动加压髋螺钉内固定系统（DHS组）25例和股骨近端髓内钉（PFNA组）35例。观察两组患者手术时间、术中平均出血量、围手术期并发症及Harris髋关节功能评分等指标。并对影响手术效果的因素进行分析。结果60例患者随访12个月后，患者内固定组均获得骨性愈合。两组患者中，手术时间最短的是PFNA组，与DHS组相比，差异有统计学意义（P〈0．05）。另外PFNA组患者术中出血量和围手术期并发症上较DHS组少，且改良Harris髋关节评分，PFNA组要优于DHS组，两组相比，差异均具有统计学意义（P〈0．05）。经多因素Logistic回归分析发现，影响股骨转子间骨折手术效果的因素较多，患者的年龄、骨折的类型、骨折复位后的稳定性及内固定强度、骨质疏松以及患者过早负重有显著的相关性。结论对于股骨转子间骨折手术的方式较多，且疗效显著。但相对于DHS组，PFNA治疗股骨转子间骨折具有操作简单、出血少、手术时间短、固定可靠。不管选择哪种手术治疗方式，一定要注意其预后的相关影响因素，避免不必要的损伤发生。

Objective To study the clinical effect of surgery for treatment of patients with inter trochanteric fractures and the factors of influence the surgery. It could provide a better way to treat the femoral inte rtrochanteric fractures. Methods A total of 60 cases with inter trochanteric fractures from March 2010 to March 2012 in our hospital were to be studied. They were divided into two groups, who were treated with DHS （25cases） and PFNA （35 cases）. The opera- tion time, mean intraoperative blood loss, postoperative complications, and the Harris hip function scores were observed. As well as influence factors affecting the surgical results were analyzed. Results All patients were followed up for 12 months. All patients in internal fixation group were obtained complete union. The operative time, blood loss, and perioperative complication of PFNA group were significantly less than the DHS groups （P〈 0.05）. The modified Harris hip score of PFNA was superior to the DHS group （P 〈 0.05）. Multivariate Logistic regression analysis showed that effects of inter trochanteric fracture surgery had many factors, e.g. the patient＇s age, the type of fracture, fracture reduction and fixation stability strength, osteoporosis and early weight-bearing patients and so on. Conclusion For in- tertrochanteric fractures treatment it has too much way, and has a significant effect. But compared to the DHS, PFNA treatment of intertrochanteric fracture is simple and has less bleeding, shorter operative time, fixed and reliable. No matter what kind of surgical treatment options, be sure to pay attention to the prognostic factors, to avoid unnecessary injury.