75岁及以上骨质疏松性股骨粗隆间骨折患者手术方法的选择

Selection of operative method and peri-operative managements for osteoporotic femoral intertrochanteric fracture in elderly patients aged 75 years and over

目的探讨75岁及以上骨质疏松性股骨粗隆间骨折患者的围术期、治疗及手术方法的选择。方法回顾分析2009年7月至2012年7月年龄75～9l岁骨质疏松性骨折患者132例，分别采用动力髋螺钉（DHS）47例、GammaⅢ钉44例和防旋型股骨近端髓内钉（PFNA）41例。分析比较3组患者围术期治疗、手术情况、骨折愈合时间、术后并发症及术后功能恢复情况。结果3组平均手术时间：GammaⅢ钉组（68．7±9．1）min和PFNA组（80．5±11．3）min较DHS组（112．2±18．4）min的平均手术时间短（均P〈0．01）。术中出血量：GammaⅢ组（156．9±18．5）ml、PFNA组（183．4±21．3）m1，较DHs组（296．2±29．6）ml平均术中出血量少（均P〈0．01）。平均骨折愈合时间GammaⅢ组（12．6±2．4）周和PFNA（13．1±2．4）周亦较DHS组（15．3±3．2）周短（均P〈0．05），而GammaⅢ钉组与PFNA组间的平均骨折愈合时间差异无统计学意义（P〉0．05）。3组术后并发症DHS组11例、GammaⅢ钉组2例和PFNA组3例（P〈0．05）。术后1年Harris评分DHS组（87．4±11．6）分、GammaⅢ钉组（90．2±13．0）分和PFNA组（88．9±12．3）分（P〉0．05）。结论对稳定性骨折，应用3种内固定皆可；对不稳定性骨折，宜选用GammaⅢ钉和PFNA。

Objective To investigate the selection of operative method and peri-operative managements for osteoporotic femoral intertrochanteric fracture in elderly patients aged over 75 years. Methods A total of 132 consecutive patients aged 75-91 years with osteoporotic intertrochanteric fractures from July 2009 to July 2012 were retrospectively analyzed. 47 patients were treated with dynamic hip screw （DHS group）, 44 patients with proximal femoral nail anti-rotation （PFNA group） and 41 patients with Gamma Ⅲ nail （Gamma Ⅲ group）. The peri-operative managements, operation circumstance, the time for fracture union, postoperative complications and the degree of functional recovery were analyzed and compared between the 3 groups. Results The mean surgical time was shorter in Gamma Ⅲ nail and PFNA groups than in DHS group [（68.7±9. 1） min, （80.5±11.3） rain w （112.2±18.4）min, both P〈0.01]. The mean blood loss was less in the Gamma Ⅲ nail and PFNA groups than in DHS group^（156.9±18.5） ml, （183.4±21.3） ml v （296.2±29.6） mh both P〈0. 013. The mean time for fracture healing was shorter in Gamma U] nail and PFNA groups than inDHSgroup 〈（12.6±2.4） weeks, （13.1±2.4） weeks w （15.3±3.2） weeks, both P〈 0. 053, and it has no obvious difference between Gamma Ⅲ nail and PFNA groups （P〉0.05）. There were significant differences in postoperative complications between Gamma Ⅲ nail, PFNA groups and DHS group （2 cases, 3 cases vs. 11 cases, P〈0.05, respectively）. The mean Harris hip score had no significantly difference among DHS, Gamma Ⅲ nail and PFNA groups （87.4±11.6, 90.2±13.0 w 88.9±12.3, both P〉0.05）. Conclusions The 3 operative methods for stable intertrochanteric fracture are feasible and effective in elderly patients, but for unstable intertrochanteric fractures, the treatment with Gamma Ⅲ nail and PFNA has advantages.