骨水泥、钉道植骨强化动力髋螺钉固定修复老年骨质疏松性股骨转子间骨折

Bone cement and bone grafting in nail path to strengthen dynamic hip screw fixation for senile osteoporotic intertrochanteric fracture

背景:对于老年骨质疏松性髋部骨折的动力髋螺钉固定,如能避免使用过程中造成的骨量丢失,或是采用其他手段增加固定螺钉把持力,将改善动力髋螺钉固定的治疗效果。目的:对比研究3种固定方式修复老年骨质疏松性股骨转子间骨折的效果。方法:回顾性分析近5年来采用常规动力髋螺钉内固定、骨水泥强化后动力髋螺钉固定及主钉道压配植骨配合动力髋螺钉固定3种固定方式治疗老年骨质疏松性股骨转子间骨折患者的资料,分别设为对照组、骨水泥组和植骨组。结果与结论:经固定后2年随访,植骨组、骨水泥组和对照组Harris髋关节功能评分优良率分别为95%,80%,70%。植骨组骨折临床愈合时间明显缩短(P<0.05),出现螺钉固定失败情况与骨水泥组相当。对照组较其他2组相对更多出现退钉等内固定失败情况。结果表明,与其他常规动力髋螺钉内固定、骨水泥强化后动力髋螺钉固定方式相比较,主钉道压配植骨配合动力髋螺钉内固定的疗效及安全性更好。

BACKGROUND：In dynamic hip screw fixation for treating aged osteoporotic intertrochanteric fracture,avoiding the loss of bone mass,or by other means that can increase the fixed screw pullout strength,will improve the therapeutic effect of dynamic hip screw fixation.OBJECTIVE：To compare the effects of three kinds of repair methods on aged osteoporotic intertrochanteric fracture.METHODS：Data of aged osteoporosis intertrochanteric fracture patients,who received conventional dynamic hip screw fixation,bone cement augmentation with dynamic hip screw fixation and bone grafting with dynamic hip screw fixation,were retrospectively analyzed.They were divided into control group,bone cement group and bone grafting group.RESULTS AND CONCLUSION：After two years of follow-up,the excel ent and good rates of Harris hip function were95%,80% and 70% in the bone grafting,bone cement and control groups,respectively.The healing time of fractures was significantly shortened in the bone grafting group（P〈0.05）.The failure of screw fixation was similar between the bone grafting and bone cement groups.Screw withdrawing appeared in the control group.Results suggest thatcompared with conventional dynamic hip screw fixation and bone cement augmentation with dynamic hip screw fixation,the therapeutic effect and safety of bone grafting in nail path with dynamic hip screw fixation were better.