两种不同金属内固定物治疗老年不稳定型骨质疏松性股骨粗隆间骨折的效果评价

Analysis of effect of two metal fixation implants in the treatment of elderly patients with osteoporotic unstable femoral intertrochanteric fractures

目的：评价两种不同髓内固定方法治疗老年不稳定型骨质疏松性股骨粗隆间骨折的临床效果。方法回顾性分析2011年1月-2014年1月于首都医科大学附属复兴医院接受手术治疗的65岁以上老年不稳定型股骨粗隆间骨折患者78例，采用亚洲型髋关节髓内钉固定47例（ASIAN IMHS组），采用InterTan系统内固定31例（InterTan组），比较两组患者手术时间、术中出血量、骨折愈合时间、髋关节功能Harris评分及术后并发症发生情况。结果所有患者均顺利完成手术。随访6-21个月，平均13.5个月。平均手术时间，ASIAN IMHS组为（66.6±13.2）min，InterTan组为（53.7±9.2）min；出血量，ASIAN IMHS组为（149.3±33.6）mL，InterTan组为（103.7±17.7）mL，InterTan组手术时间及出血量均小于ASIAN IMHS组，两组比较差异有统计学意义（P〈0.05）。骨折愈合时间ASIAN IMHS组为（12.6±1.5）周，InterTan组为（12.2±1.2）周，两组比较差异无统计学意义（P〉0.05）。髋关节功能Harris评分ASIAN IMHS组优良率为90.7%，InterTan组优良率为90.0%；并发症方面，ASIAN IMHS组1例随访时发生股骨头切出，InterTan组1例患者术中主钉置入过程中发生内固定远端股骨干裂纹骨折；两组骨折愈合时间、Harris评分优良率及并发症发生率比较，差异均无统计学意义（P〉0.05）。结论亚洲型髋关节髓内钉和InterTan系统均为治疗老年不稳定型骨质疏松性股骨粗隆间骨折的有效手段，后者操作更为简便，对于一般情况较差的患者更为适用。

Objective To compare the effect of Asian intramedullary hip screw and InterTan system in the treatment of elderly patients with unstable femoral osteoporotic intertrochanteric fractures. Methods 78 elderly patients （age≥65 years） with unstable osteoporotic intertrochanteric fractures were treated by operation from January 2011 to January 2014 in Fuxing Hospital Affiliated of Capital Medical University, of which 47 patients were treated by ASIAN IMHS （ASIAN IMHS group）, and 31 patients were treated by InterTan system （InterTan group）. The operation time, amount of blood loss, fracture healing time, and incidence rate of complications between two groups were analyzed. Results All the patients were operated successfully, follow-up durations ranged from 6 to 21 months （mean 13.5 months）. The oper-ation time was （66.6±13.2） min in ASIAN IMHS group, and （53.7±9.2） min in InterTan group, the amount of blood loss was （149.3±33.6） mL in ASIAN IMHS group, and （103.7±17.7） mL in InterTan group, both the operation time and amount of blood loss in InterTan group were less than those in the ASIAN IMHS group, the differences were statistical-ly significant （P〈 0.05）. The fracture healing time was （12.6±1.5） weeks in ASIAN IMHS group, and （12.2±1.2） weeks in the InterTan group. 90.7% of patients were with excellent Harris Hip score in the ASIAN IMHS group, which were 90.0% in the InterTan group. 1 patient was with cut out of the femur neck in the ASIAN IMHS group, and 1 patient was with fracture of femoral shaft in the InterTan group, there was no statistical difference was observed in fracture healing time, Harris score of the hip function and incidence rate of complications between two groups （P〉0.05）. Con-clusion Both Asian IMHS and InterTan system are quite effective for treating unstable osteoporotic intertr ochanteric fractures, InterTan system is more simple, and more suitable for patients in sever condition.