早期整体治疗模式治疗老年股骨转子间骨折的临床疗效

Early total care pattern for intertrochanteric fracture of femur in the elderly

目的 ：探讨早期整体治疗模式治疗老年股骨转子间骨折的临床疗效。方法 ：回顾性分析2012年1月至2015年2月收治的106例老年股骨转子间骨折患者的临床资料,按患者是否接受早期整体治疗模式治疗分为两组,其中采用早期整体治疗模式治疗的34例患者为ETC模式组,男14例,女20例;年龄70~86岁,平均（74.88±4.38）岁;Evans分型：Ⅰ型4例,Ⅱ型5例,Ⅲ型13例,Ⅳ型11例,V型1例。采用传统创伤骨科治疗模式治疗的72例患者为传统模式组,男35例,女37例;年龄70~85岁,平均（74.46±3.63）岁;Evans分型：Ⅰ型8例,Ⅱ型13例,Ⅲ型25例,Ⅳ型25例,V型1例。所有患者采用股骨近端防旋髓内钉固定治疗。比较两组患者受伤至手术时间、住院时间、术后下地活动时间、住院期间并发症、术后1年死亡例数及术后12个月随访时的Harris评分。结果：两组患者均获得随访,ETC模式组随访12~18个月,平均（13.29±1.51）个月;传统模式组随访12~16个月,平均（12.93±1.15）个月,两组比较差异无统计学意义（t=1.368,P=0.174）;ETC模式组死亡2例,传统模式组死亡8例,两组比较差异无统计学意义（χ2=0.739,P=0.318）;ETC模式组住院期间3例出现并发症,传统模式组20例,两组比较差异有统计学意义（χ~2=6.732,P=0.010）;ETC模式组受伤至手术时间、住院时间、术后下地活动时间分别为（2.03±0.67）d、（15.41±2.87）d、（3.62±0.74）d,传统模式组分别为（4.17±1.59）d、（20.11±4.24）d、（5.35±1.22）d,两组比较差异有统计学意义;ETC模式组术后12个月Harris评分（82.32±4.56）与传统模式组（79.24±5.52）比较差异有统计学意义（t=2.833,P=0.006）。结论 ：早期整体治疗模式是治疗老年股骨转子间骨折的一种新兴诊疗模式,可缩短受伤至手术时间、住院时间、术后下地活动时间,减少住院期间并发症,促进患者术后功能恢复。

Objective：To evaluate clinical results of early total care （ETC） treatment for elderly patients with intertrochanteric femur fractures. Methods：Clinical data of 106 elderly patients with intertrochanteric fracture treated from January 2012 and February 2015 were retrospectively studied. According to whether receiving the early total care mode, the patients were divided into 2 groups, 34 cases were diagnosed and treated with early total care pattern （ETC group）, including 14 males and 20 females with an average age of （74.88±4.38） years old ranging from 70 to 86. According to Evans types ,4 cases were type Ⅰ , 5 cases were type Ⅱ , 13 cases were type Ⅲ,11 cases were type Ⅳ, 1 case was type Ⅴ. Seventy-two patients were treated with conventional trauma method （conventional group）,including 35 males and 37 females with an average age of （74.46±3.63） years old ranging from 70 to 85. According to Evans type, 8 cases were type Ⅰ , 13 cases were type Ⅱ , 25 cases were type Ⅲ,25 cases were type Ⅳ, and 1 case was type Ⅴ. All fractures were treated with proximal femoral nails anti-rotation （PFNA）. Operative time, hospital stays, leaving bed time, complications, cases of death at 1 year after operation, postoperative Harris score at 12 months were observed and compared. Results：All patients were followed up,the time of ETC group ranged from 9 to 18 months with an average of 13.29±1.51 ,and the time in conventional group ranged from 12 to 16 months with an average 12.93±1.15, while there was no significant difference between two groups in time of following-up （t=1.368, P=0.174）. There was no significant meaning in cases of death between ETC group （2 cases） and conventional group （8 cases）. Three cases occurred complications in ETC group,and 20 cases in conventional group,there was obvious meaning between two groups （χ^2=0.739, P=-0.318 ）. Operative time, hospital stays,leaving bed time in ETC group respectively was （2.03 ±0.67 ） d, （15.41±2.87） d and （3.62±0.74） d;while in conventional group respectively was （4.17±1.59） d, （20.11±4.24） d and （5.35±1.22） d; there were significant differences between two groups in operative time, hospital stays,leaving bed time. Postoperative Harris scores at 12 months in ETC group was （82.32±4.56） ,and （79.24±5.52） in conventional group,there was obvious meaning between two groups （t=2.833, P=-0.006）. Concluslon： ETC pattern is a novel method for diagnosis and treatment of intertrochanteric femur fractures in elderly, it could shorten operative time, hospital stays,leaving bed time, decrease complications and promote recovery of function.