三种手术方式治疗高龄股骨粗隆间骨折的疗效比较

Comparison of the Effect of Three Internal Fixation Methods in the Treatment of the Aged Femoral Interochanteric Fractures

目的：探讨三种不同内固定方法治疗高龄股骨粗隆间骨折的临床疗效。方法：2008年1月-2013年6月笔者所在医院收治的高龄（≥80岁）股骨粗隆间骨折并通过手术治疗的患者共128例：其中经皮加压钢板（PCCP组）固定47例，动力髋加压螺钉（DHS组）固定57例，股骨近端解剖锁定板（LCP组）固定24例，比较疗效。结果：PCCP组2例失访，45例患者术后获平均10.5个月（8~15个月）的随访；DHS组3例失访，54例患者术后获平均11.2个月（10~17个月）的随访；LCP组1例失访，23例患者术后获平均11.5个月（8~17个月）的随访。三组骨折愈合时间、并发症及Harris关节功能评分比较，差异无统计学意义（P＆gt;0.05）。结论：三种手术方式均有较好的效果。对高龄患者来说，PCCP和微创DHS是最合适的。不能耐受麻醉的患者，PCCP更为合适。严重骨质疏松的患者，PCCP或近端锁定钢板更为合适。针对粉碎性骨折，选择近端锁定钢板更好。采用PCCP的内固定方式可以允许患者早期部分负重。

Objective： To separately investigate the best surgical tactic among the DHS, LCP and PCCP for each senior patients with different fracture condition.Method： The surgeries were performed in Wuxi People＇s Hospital from January 2008 to June 2013, 47 patients aged over 80 years old with intertrochanteric femoral fractures were treated with PCCP method（the PCCP group）, 57 patients with DHS method（the DHS gruop） and 24 patients with LCP method（the LCP group）, the effect of three groups were compared.Result： In the PCCP group, from 8 to 15 months（mean 10.5 months） follow-up after surgery, whereas the DHS group had from 10 to 17 months（mean 11.2 months） follow-up and the LCP group had from 8 to 17 months（mean 11.5 months） follow-up.The mean healing time, complications and Harris Hip Scores of three groups, there was no statistical significanee（P〈O.O5）.Conclusion ： Each surgery method performes wc}l. The PCCP group and DHS group have a better prognosis.The PCCP and LCP technique, performe better among the patients with severe osteopenia or osteoprosis. The LCP system indicates better osteogensis and restoration of hip function in eomminutied fracture.The PCCP method allowes the patients early-stage and partial weight bearing, which enhances the rehabilitation.And we also find, for the patient being intolerance to anesthesia, the PCCP is the outstanding way to surgery.