DHS与Intertan治疗老年患者股骨粗隆间Evans Ⅰ型骨折的疗效比较

Efficacy Comparison between DHS and Intertan in the Treatment of Elderly Patients with Evans Type Ⅰ Intertrochanteric Fracture

目的：比较闭合复位动力髋螺钉（dynamic hip screw,DHS）与闭合复位股骨近端髓内钉Intertan治疗老年患者股骨粗隆间EvansⅠ型骨折的疗效。方法：手术治疗股骨粗隆间骨折（EvansⅠ型）老年患者70例,其中行闭合复位DHS内固定术30例（DHS组）,行闭合复位Intertan内固定术40例（Intertan组）。结果：患者均获随访,时间6-24（12.0±3.0）个月。骨折均愈合,未出现内固定失败、股骨头坏死等并发症。手术时间：DHS组40-90（63.6±8.4）min,Intertan组40-90（55.6±9.8）min;术中出血量：DHS组100-200（145.4±22.5）mL,Intertan组100-200（92.4±25.5）mL;住院时间：DHS组6-16（11.2±2.8）d,Intertan组6-9（7.9±1.1）d;两组手术时间、术中出血量、住院时间比较,差异有统计学意义（P〈0.05）。DHS组4例患者术后手术切口液化,换药后愈合。骨折愈合时间：DHS组2.5-4.0（3.4±0.8）个月,Intertan组2.5-4.0（3.2±0.7）个月,两组差异无统计学意义（P〉0.05）。术后髋关节Harris总评分：DHS组67-84（73.5±5.1）分,Intertan组70-86（77.9±3.7）分;功能评分：DHS组23-40（30.8±3.2）分,Intertan组25-44（34.4±2.9）分;两组术后髋关节Harris总评分和功能评分比较,差异有统计学意义（P〈0.05）。疼痛评分：DHS组为20-44（34.9±4.8）分,Intertan组为20-44（35.8±5.0）分;活动范围评分：DHS组2-4（3.0±0.8）分,Intertan组2-4（3.0±1.0）分;两组疼痛评分和活动范围评分比较,差异均无统计学意义（P〉0.05）。结论：Intertan和DHS内固定都是治疗老年患者股骨粗隆间骨折的有效手段,但前者创伤较小,住院时间较短,髋关节功能恢复更好。

Objective ：To compare the clinical efficay between dynamic hip screw （DHS）and proximal femoral nail（Intertan） fixation after closed reduction for the treatment of elderly patients with Evans type Ⅰ intertrochanteric fracture .Methods ：Among 70 elderly patients with intertrochanteric fracture （Evans Ⅰ ） undergoing surgical treatment ,30 cases （DHS Group） were treated by closed reduction and DHS internal fixation and the other 40 cases （Intertan Group） were treated by closed reduction and Intertan fixation .Results ：All the patients were followed up for 6-24 （12 .0 ± 3 .0） months .All the fractures were healed and no complication such as failure of internal fixation or femoral head necrosis occurred . There was statistically significant difference between operation time the DHS group and the Intertan group with 40-90 （63 .6 ± 8 .4） min and 40-90 （55 .6 ± 9 .8） min in DHS Group and Intertan Group ,respectively .And the intraoperative blood loss were 100-200 （145 .4 ± 22 .5） mL and 100-200 （92 .4 ± 25 .5） mL in DHS Group and Intertan Group ,respectively .Furthermore ,the duration of stay were 6-16 （11 .2 ± 2 .8） days and 6-9 （7 .9 ± 1 .1） days in DHS Group and Intertan Group ,respectively .There were significant difference regarding operation time ,intraoperative blood loss ,and duration of stay between the two groups（P〈 0 .05） .Wound healing were achieved by postoperative liquefaction wound care in 4 cases of DHS group .There was no significant difference regarding fracture healing time between the 2 .5-4 .0 （3 .4 ± 0 .8） months in DHS Group and the 2 .5-4 .0 （3 .2 ± 0 .7） months in Intertan Group（P＆gt; 0 .05） .There were statistically significant differences between the two groups regarding Harris function scores after operation ,which were 67-84 （73 .5 ± 5 .1） points in DHS Group and 70-86 （77 .9 ± 3 .7） points in Intertan Group , and function scores which were 23-40 （30 .8 ± 3 .2） points in DHS Group and 25-44 （34 .4 ± 2 .9） points in Intertan Group （P〈0 .05） .There was no significant difference between two groups regarding pain scores ,which were 20-44 （34 .9 ± 4 .8） points in DHS Group and 20-44 （35 .8 ± 5 .0） points in Intertan Group ,and activity range scores ,which were 2-4 （3 .0 ± 0 .8） points in DHS Group and 2-4 （3 .0 ± 1 .0） points in Intertan Group （P＆gt; 0 .05） .Conclusions ：The Intertan and DHS internal fixation are effective methods for the treatment of elderly patients with intertrochanteric fractures .Intertan showed less trauma ,shorter duration of stay ,and better recovery of hip function .