Othofix转子间外固定架治疗老年股骨转子间骨折疗效观察

CLINICAL OBSERVATION OF Othofix PERTROCHANTERIC FIXATOR FOR FIXATION OF INTERTROCHANTERIC FRACTURE

目的探讨Othofix转子间外固定架治疗老年股骨转子间骨折的临床疗效。方法回顾分析2012年10月-2015年3月,采用闭合复位Orthofix转子间外固定架治疗的36例老年股骨转子间骨折患者（外固定架组）临床资料,并与同期行闭合复位Gamma钉内固定治疗的47例股骨转子间骨折患者（Gamma钉组）进行比较。两组患者性别、年龄、致伤原因、侧别、骨折AO分型、合并内科疾病及受伤至手术时间等一般资料比较差异均无统计学意义（P〉0.05）,具有可比性。记录并比较两组患者手术时间、术中失血量、住院时间、骨折愈合时间及并发症等;术后根据Sanders髋关节创伤后功能评定标准进行髋关节功能评分。结果外固定架组患者手术时间、术中失血量及住院时间均显著低于Gamma钉组（P〈0.05）。两组患者均获随访,随访时间6-12个月,平均8.8个月。术后两组患者切口均Ⅰ期愈合。外固定架组和Gamma钉组骨折均获骨性愈合,愈合时间外固定架组明显少于Gamma钉组（t=14.780,P=0.000）。两组均无骨道感染、骨髓炎等深部感染发生。外固定架组14例（38.9%）出现轻微表浅软组织钉道感染,Gamma钉组未出现切口感染,两组比较差异有统计学意义（χ2=22.010,P=0.001）。外固定架组出现轻度髋内翻3例（8.3%）、半针切出2例（5.6%）,Gamma钉组分别为4例（8.5%）和3例（6.4%）,两组并发症发生率比较差异无统计学意义（χ2=0.001,P=0.960;χ2=0.025,P=0.830）。术后6个月根据Sanders髋关节创伤后功能评定标准评价,外固定架组优16例、良15例、可3例、差2例,优良率86.1%;Gamma钉组优22例、良20例、可4例、差1例,优良率89.4%;两组比较差异无统计学意义（χ2=0.200,P=0.610）。结论闭合复位Othofix转子间外固定架治疗老年股骨转子间骨折具有手术时间短、操作简便、出血量少、固定可靠、手术风险小、患者术后恢复快等优点,临床效果满意。

Objective To evaluate the effectiveness of Othofix pertrochanteric fixator for fixation of intertrochanteric fracture. Methods A retrospective analysis was made on the clinical data from 36 cases of intertrochanteric fracture treated with Othofix pertrochanteric fixator（OPF group） and 47 cases treated with Gamma nail（Gamma group） between October 2012 and March 2015. There was no significant difference in gender, age, cause of injury, side, AO fracture classification, combined medical disease, and injury to operation time between 2 groups（P0.05）. The operation time, intraoperative blood loss, hospitalization time, fracture union time, and complication rate were recorded and compared between 2 groups. Hip function was evaluated with Sanders post-trauma criteria. Results The operation time, intraoperative blood loss, and hospitalization time of the OPF group were significantly less than those of the Gamma group（P0.05）. All the cases were followed up 6-12 months（mean, 8.8 months） in 2 groups. Healing of incision by first intention was obtained. Bone union was achieved in 2 groups, and the fracture union time of the OPF group was significantly shorter than that of the Gamma group（t=14.780, P=0.000）. There was no deep wound or pin track infection in 2 groups. Superficial skin reactions developed around the screw and the pins in 14 cases（38.9%） of the OPF group, but no incision infection in the Gamma group, showing significant difference（χ2=22.010, P=0.001）. Mild varus of the hip and pin cutting-out occurred in 3 cases（8.3%） and 2 cases（5.6%） of the OPF group, and in 4 cases（8.5%） and 3 cases（6.4%） of Gamma group, showing no significant difference（χ2=0.001, P=0.960; χ2=0.025, P=0.830）. According to Sanders post-trauma criteria, the results were excellent in 16 cases, good in 15 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.1% in the OPF group; the results were excellent in 22 cases, good in 20 cases, fair in 4 cases, and poor in 1 case, with an excellent and good rate of 89.4% in the Gamma group; and there was no significant difference（χ2=0.200, P=0.610）. Conclusion The Othofix pertrochanteric fixator has good effectiveness in the treatment of intertrochanteric fracture, which has the advantages of simple operation, less operation time, little bleeding, and early functional recovery.