外支架固定治疗老年股骨转子间骨折的疗效观察

Efficacy of external stent fixation in elderly patients with intertrochanteric fractures

背景:老年股骨转子间骨折多为骨质疏松性骨折,常见的手术治疗主要有防旋股骨近端髓内钉(PFNA)内固定和外固定支架治疗,但哪种手术方式更为安全、可靠,仍然存在争议。目的:比较外支架固定治疗和PFNA治疗老年股骨转子间骨折的疗效。方法方法:选取2009年1月至2013年12月在我院就诊的老年股骨转子间骨折患者90例,根据治疗方法不同分为外支架组和PFNA组,每组45例。比较两组治疗后的疗效,术中出血量,手术时间,术后消肿时间,住院时间,骨折愈合时间,负重时间和并发症发生率。结果:外支架组的优良率为82.22%,PFNA组的优良率为86.67%,两组的优良率差异无统计学意义(χ2=0.084,P>0.05)。外支架组的术中出血量为(43.83±11.53)ml,手术时间为(35.64±12.29)min,术后消肿时间为(7.06±1.17)d,住院时间为(7.86±0.97)d,骨折愈合时间为(10.38±1.43)周,完全负重时间为(35.98±2.59)d,均显著少于PFNA组[(68.39±12.84)ml,(45.14±13.85)min,(8.48±2.06)d,(11.83±1.83)d,(12.32±1.28)周,(38.53±3.82)d,P<0.01]。PFNA组的术后并发症发生率为22.44%,明显高于外支架组的6.67%(χ2=4.415,P<0.05)。结论:外支架固定治疗股骨转子间骨折疗效确切,具有创伤少、固定可靠、并发症少的特点,值得临床推广应用。

Background： Intertrochanteric fractures in elderly patients is osteoporotic.Proximal femoral nail antirotation（PFNA） fixation and external stent fixation are usually used for the treatment. But what modus operandi is more reliable is in dispute.Objective： To compare the clinical outcome between external stent fixation and proximal femoral nail antirotation（PFNA）in the treatment of intertrochanteric fractures in elderly patients.Methods： Ninety elderly patients with intertrochanteric fractures treated between January 2009 and December 2013 were enrolled in the retrospective study. They were divided into external fixation group and PFNA group according to different treatment methods, and there were 45 patients in each group. After treatment, the efficacy, blood loss, operative time, postoperative swelling, hospitalization time, healing time, loading time, and complication were observed and compared between two groups.Results： The excellent and good rate was 82.22% in the external fixation group, and 86.67% in the PFNA group（χ^2=0.084,P〉0.05）. In the external fixation group, the blood loss, operative time, postoperative swelling period, hospital stay, healing time and loading time were（43.83±11.53） ml,（35.64±12.29） min,（7.06±1.17） d,（7.86±0.97）d,（10.38±1.43） weeks,（35.98±2.59） d, respectively, which were significantly lower than those in the PFNA group（[68.39±12.84] ml, [45.14±13.85] min,[8.48±2.06] d, [11.83±1.83] d, [12.32±1.28] weeks, [38.53±3.82] d, P〈0.01）. The incidence of pospoperative complication was in the PFNA group was significantly higher than that in the external fixation group（22.44% vs 6.67%, χ^2=4.415, P〈0.05）.Conclusions： External stent fixation is suitable for elderly intertrochanteric fracture due to less trauma, reliable fixation, and fewer complications.