小切口DHS内固定联合骨水泥灌注治疗老年股骨粗隆间骨折

Internal fixation of dynamic hip screw combined with cement for treatment of the aged patients with osteoporotic femoral intertrochanteric fracture

目的观察小切口动力髋螺钉（DHS）内固定联合骨水泥强化治疗老年骨质疏松性股骨粗隆间骨折的疗效。方法自2012-07—2014-02诊治老年骨质疏松性股骨粗隆间骨折39例,21例采用小切口DHS内固定配合骨水泥灌注强化治疗（骨水泥组）,18例单纯采用小切口DHS内固定术（单纯组）。观察2组手术时间、术中出血量、骨折愈合时间及末次随访时髋关节功能Harris评分。结果 2组围手术期无死亡患者。所有患者术后获得平均11.4（5～18）个月随访。骨水泥组：围手术期无骨水泥相关并发症发生,随访期间未发现内固定切割股骨头、内固定松动等并发症;末次随访时髋关节功能Harris评分：优10例,良9例,可2例,优良率90.5%。单纯组：1例内固定松动切割股骨头,经卧床非手术治疗后骨折愈合;末次随访时髋关节功能Harris评分：优8例,良7例,可3例,优良率83.3%。2组手术时间、术中出血量、骨折愈合时间差异无统计学意义（P〉0.05）。结论小切口DHS内固定联合骨水泥灌注治疗老年骨质疏松性股骨粗隆间骨折在不增加手术时间及创伤的情况下提高了内固定的稳定性,患者可早期活动,临床效果满意。

Objective To observe the therapeutic efficacy of internal fixation of dynamic hip screw（DHS） combined with cement for the aged patients with osteoporotic femoral intertrochanteric fracture. Methods All 39 aged patients with osteoporotic femoral intertrochanteric fracture were followed up from July 2012 to February 2014, of which, 21 cases of the aged osteoporotic femoral intertrochanteric fractures were surgically treated by internal fixation of DHS combined with cement（group of cement）, 18 cases, treated by internal fixation of DHS only（group of simpleness）. The time of operation, blood loss in operation, the time of bone union and Harris score system on last following up in two groups were evaluated. Results There was no mortality in two groups. All 39 cases of the aged osteoporotic femoral intertrochanteric fractures were followed up from five to eighteen months. The time of operation, and blood loss, the time of union and Harris on last following up in two groups were evaluated. Group of cement： There was no complications of cement concerned in perioperative period, no complications such as the lag-screw cutting-out, internal fixation looseness in following up; According to Harris score system on last following up, 10 cases were excellent, 9 cases were good, 2 cases were acceptable, the excellent and good rate was 90.5%.Group of simpleness： Internal fixation loosening and lag-screw cutting-out occurred in 1 case, bone union was gained after lying in bed. According to Harris score system on last following up, 8 were excellent, 7 were good, 3 were acceptable.Excellent and good rate was 83.3%. There was no statistical difference in time of operation, blood loss in operation and union time between two groups（P〉 0.05）. Conclusion Internal fixation of DHS combined with cement can improve the stability of the internal fixation, shorten the time of operation and lessen trauma. This surgical method can be used to facilitate early activity for the aged patients with osteoporotic femoral intertrochanteric fracture and the clinical efficacy is satisfied.