防旋动力髋螺钉与动力髋螺钉治疗高龄股骨粗隆间骨折的疗效比较

Comparison of DHSA and DHS for the treatment of femoral intertrochanteric fracture in elderly patients

目的探讨防旋动力髋螺钉（DHSA）与动力髋螺钉（DHS）在治疗高龄股骨粗隆间骨折的近期疗效差异。方法回顾性分析2011年1月～2013年1月间收治的68例65岁以上股骨粗隆间骨折病例，DHS组37例，DHSA组31例。比较两组的术前基本情况（性别、年龄、患肢侧别、骨折类型、术前并发症），术中平均手术时间，平均出血量，术后内固定有否切出股骨头，术后骨折平均愈合时间，髋关节Harris评分。结果随访9～32个月，平均（21．5±8．5）个月。两组术前基本情况差异不具有统计学意义（P〉0．05）；所有病例随访时间内未发现感染，DHSA组无骨折不愈合，无刀片切出股骨头，手术时间短，术中出血少，术后骨折平均愈合时间快。Harris评分DHSA组明显高于DHS组，差异有统计学意义（P〈0．05）。结论DHSA与DHS均可实现老年股骨粗隆间骨折的良好固定，DHSA固定技术固定可靠，抗旋转，填压松质骨，手术创伤小，更适合骨质疏松性股骨粗隆间骨折患者，值得临床推广及进一步深入研究。

Objective To explore the curative effects of dynamic hip screw guide system （DHSA） and dy- namic hip screw （ DHS } in the treatment of femoral intertrochanteric fracture in elderly patients. Methods Totally 68 patients over the age of 65 who suffered from femoral intertrochanteric fractures from Jan. 2011 to Jan. 2013 were retrospectively studied. Among them,37 cases were in DHS group and 31 cases in DHSA group. Preoperative basic information （ gender, age, side of injured limb, fracture type, preoperative complications ） , intraoperative average operation time, average blood loss, cut-out of femoral head, time of union and Harris score of the two groups were compared. Results The mean period of follow-up was （ 21.5 ± 8.5 ） months （ range, 9 to 32 months）. Preoperative basic situation of the two groups had no statistically significant difference （ P 〉 0. 05 ）. No infection and cut - out of femoral head occurred in DHSA group. Shorter operation time, less intraoperative bleeding and faster average heal- ing time were found in patients in DHSA group. Harris score in DHSA group was significantly higher than in DHS group and the difference was statistically significant （ P 〈 0. 05 ）. Conclusion DHSA and DHS can achieve good fixation for elderly femoral intertrochanteric fractures. DHSA technology has advantages such as reliable fixation, anti-rotation,reduced cut-out, cancellous bone filling,less surgical trauma. It is more suitable for osteoporotic intertrochanteric fracture patients and worth of clinical promotion and further in-depth study.