不同治疗方式在老年股骨粗隆间骨折中的对照分析

A Comparison of Different Methods in Treatment of Femoral Intertrochanteric Fractures in Elderly Patients

目的:比较分析不同治疗方式对老年股骨粗隆间骨折的治疗效果。方法:回顾性分析152例老年股骨粗隆间骨折患者的临床资料,保守治疗组24例;手术治疗组128例,其中人工股骨头置换23例、外固定架23例、髓内固定28例(包括股骨近端髓内钉(proximal femoral nail,PFN)、Gamma钉等)、动力髋螺钉(dynamic hip screw,DHS)26例、股骨近端锁定钢板(the locking compress plate,LCP)28例。对各种治疗方式的相关指标进行比较分析。结果:手术治疗组患者卧床时间和并发症发生率均显著优于保守治疗组(t=8.045,7.583,8.673,8.023,8.672,X2=9.124,4.809,6.603,4.276,14.444,P<0.05);各手术组之间比较:各组卧床时间无显著差异(F=0.241,P>0.05),外固定架组和LCP组手术时间、切口长度、出血量及术后引流量均显著优于其余各组(P<0.05);保守组术后Harries评分低于手术组。结论:手术治疗老年股骨粗隆间骨折可获得满意疗效,且并发症较少;外固定架创伤较小,LCP和人工股骨头置换术后疗效较好,其中LCP可作为优先考虑方案。

Objective： To investigate the clinical efficacy of different methods in treating femoral intertrochanteric fracture of aged patients. Methods： A retrospective study of 196 patients with femoral intertrochanteric fractures was made. They were treated with non-surgical （24 cases）, artificial femoral head（23 cases）, external fixator（23 cases）, Proximal femoral nail （PFN） or Gamma（28 cases）, Dynamic hip screw （DHS, 26 cases）, and locking corn press plat （LCP, 28 cases）. The relevant indicators between different treatment modalities were compared. Results： There were significant difference between surgical and non-surgical groups in out-of-bed time and complications （t=-8.045, 7.583, 8.673, 8.023, 8.672, X2=-9.124, 4.809, 6.603, 4.276, 14.444, P〈0.05）; The out-of-bed time between the surgical groups had no significant difference （F=0.241, P〉0.05）; There were significant difference in external fixator and LCP with other groups in operation time, the incision length, blood loss and drainage （P〈0.05）; Non-surgical group＇s Harries score is lower than that in the surgery group. Conclusion： Surgical treatment had some superiority with femoral intertrochanteric fractures; External fixator had less trauma, LCP and artificial femoral head had better clinical outcomes. LCP can be considered as a nrinrltv nrntrr^rn