长短InterTan髓内钉结合早期整体治疗模式治疗老年股骨转子间骨折的疗效比较

Curative effect of long versus short InterTan intramedullary nailing of senior intertrochanteric hip fracture in conjunction with early total care

目的比较长短InterTan髓内钉结合早期整体治疗（ETC）模式治疗老年股骨转子间骨折的临床疗效。方法前瞻性分析2011年1月-2013年9月收治的30例老年股骨转子间骨折患者资料，所有患者均在伤后72h内按ETC模式接受手术治疗，其中15例InterTan长髓内钉治疗（长钉组），15例InterTan短髓内钉治疗（短钉组）。比较两组手术时间、术中出血量、愈合时间、髋关节Harris评分、回归术前状态时间和内固定失败情况。结果长钉组手术时间为（77．25±7．38）min，短钉组手术时间为（72．10±6．90）min（P〈0．01）。患者术后回归术前状态时间长钉组为（7．45±1．61）个月，短钉组为（8．57±2．18）个月（P〈0．05）。长、短钉组术中出血量分别为（180．75±38．26）ml和（178．62±34．79）ml；骨折愈合时间分别为（4．82±1．12）个月和（4．76±1．04）个月；髋关节Harris评分分别为（83．75±1．71）分和（82．57±2．18）分（P均〉0．05）。结论InterTan长短髓内钉结合ETC模式是治疗老年股骨转子间骨折的有效方法。相对于短钉组，长钉组患者更早恢复至术前状态。

Objective To compare the clinical outcomes of long and short InterTan intramedullary nailing of senior intertrochanteric hip fracture in conjunction with early total care （ ETC ）. Methods In this prospective study, records of 30 eider patients with intertrochanteric fracture hospitalized between January 2011 and September 2013 were included. Using the concept of ETC, the patients were treated with long （ long-nail group, n = 15 ） and short InterTan intramedullary nails （ shortnail group, n = 15） within 72 hours postinjury. The two groups were compared for operation time, intraoperative blood loss, fracture healing time, Harris hip score, time to pre-injury mobilization and hardware failure rate. Results Operation time was （77.25 ＋ 7.38 ） minutes in long-nail group versus （72.10 ＋ 6.90） minutes in short-nail group （ P 〈 0.01 ）. Time to pre-injury mobilization was （ 7.45 ＋ 1.61 ） months in long-nail group versus （ 8.57 ＋ 2.18 ） months in short-nail group （ P 〈 0.05 ）. There were no significant differences between long- and short-nail groups regarding the blood loss [ （ 180.75 ＋ 38.26）ml vs （178.62 ＋ 34. 79）ml], fracture healing time [（4.82 ＋ 1.12） months vs （4.76 ＋ 1.04） months ], and Harris hip score [ （ 83.75 ＋ 1.71 ） points vs （ 82. 57＋ 2. 18 ） points ] （ P 〉 0. 05 ）.Conclusions Either long or short InterTan intramedullary nailing combined with ETC is effective in treatment of intertroehanteric hip fracture in the elderly. However patients treated with long nails return to pre-injury mobilization relatively earlier. Long InterTan intramedullary nail system is better for the patients combined with serious osteoporosis.