动力髋螺钉治疗老年性股骨粗隆间骨折的疗效分析

Therapeutic efficacy of dynamic hip screw internal fixation on intertrochanteric fracture in elderly patients

目的 探讨动力髋螺钉（DHS）治疗老年股骨粗隆间骨折的临床疗效,以期为提高老年股骨粗隆间骨折临床治疗效果提供有效依据。方法 对2008年9月—2012年9月56例老年股骨粗隆间骨折患者经过充分的围手术期处理后,采用动力髋螺钉内固定方法进行治疗,术后不需要外固定,术后2d即可行早期无负重功能锻炼,1个月后则可下床扶拐行部分负重活动,2个月则可负重行走。无手术相关并发症发生。回顾性分析其临床疗效。术后随访6～18个月,平均12个月,并依据Harris髋关节评分标准进行髋关节功能评估。结果 56例老年股骨粗隆间骨折患者行动力髋螺钉内固定术,手术时间平均70min（60～130min）,术中出血量平均为300ml（250～600ml）,住院时间7～14d,平均9d,术后随访调查显示股骨粗隆间骨折均给予解剖复位,颈干角及对位对线良好。手术切口均一期愈合,无切口及深部感染发生,髋关节功能均恢复良好。髋关节评分优47例,良6例,中3例,优良率为94.64%。结论 采用动力髋螺钉内固定治疗老年股骨粗隆间骨折可获得较为满意的疗效,且手术时间短,手术创伤少,能促进患者早期功能锻炼,康复快,还能有效地减少并发症的发生,保证其预后质量。此手术方法操作易于掌握,临床效果显著,值得临床推广使用。

Objective To investigate the clinical efficacy of dynamic hip screw（ DHS） internal fixation in the treatment of intertrochanteric fracture in elderly patients,and provide an effective basis for improving clinical treatment effect. Methods Fifty-six cases of aged intertrochanteric fracture in our hospital from September 2008 to September 2012 received DHS internal fixation after sufficient perioperative management. There was no postoperatively external fixation. The postoperative non-weight bearing early functional exercise was begun 2 d after the operation,partial weight-bearing activities by crutches was performed within one month,and full weight-bearing exercises were carried within 2 months. The clinical effect and complications were observed. The followed-up was 6- 18 months,average 12 months. Harris hip scores system was conducted to assess the hip function. Results The average time of operations was 70 min（ 60- 130 min）,average intraoperative blood loss was 300 ml（ 250- 600 ml）,hospital stay was 7- 14 d with an average of 9 d. The postoperative follow-up showed that all intertrochanteric fractures achieved anatomical repositioning,neck stem angle and counterpoint was good to the line; the operation incision healed in the first intention; there was no incision and deep infections; the hip joint function recovered well. Harris hip scores showed excellent in 47 cases,good in 6 cases and medium in 3 cases, with a good rate of 94. 64%. Conclusion DHS in the treatment of intertrochanteric fracture obtained satisfactory results with short operation time and less trauma,and can promote early functional exercise,ensure the patients recover soon and the quality of prognosis,and reduce complications. It was easy to master. This technique had significant clinical effect,and was worth promoting.