两种内固定治疗老年股骨粗隆间骨折的疗效比较

Comparison of the efficacy on intertrochanteric fracture of femur in senile patients with two internal fixation methods

目的比较解剖型髋动力带锁钢板和动力髋螺钉治疗老年股骨粗隆间骨折的临床疗效。方法回顾性分析我院2012年9月-2013年12月54例老年股骨粗隆间骨折的治疗方法,其中解剖型髋动力带锁钢板组28人,动力髋螺钉组26人。比较分析两组患者的术中出血量、手术时间、住院时间、下地负重时间、骨折愈合时间、术后并发症及术后1年髋关节功能评价,并用SPSS19.0软件进行统计学分析。结果获随访患者54例,随访时间为13-17个月,平均14.6个月。解剖型髋动力带锁钢板内固定组比动力髋螺钉内固定组下地负重时间早、骨折愈合时间短,差异具有统计学意义（P〈0.05）,术中出血量、手术时间、住院时间无明显统计学意义（P〉0.05）。术后1年髋关节功能评价解剖型髋动力带锁钢板内固定组与动力髋螺钉内固定组相比较无明显统计学意义（P〉0.05）。术后并发症解剖型髋动力带锁钢板内固定组并发症总发生率低于动力髋螺钉组,差异具有统计学意义（P〈0.05）。结论应用解剖型髋动力带锁钢板内固定治疗老年股骨粗隆间骨折具有下地负重时间早、骨折愈合时间短、术后并发症发生率低的优点。对于老年股骨粗隆间骨折,解剖型髋动力带锁钢板内固定比动力髋螺钉内固定具有更多的优势,可以作为一种优先考虑的内固定系统。

Objective The purpose of this study is to compare the efficacy of two different internal fixation methods for the treatment of intertrochanteric fracture of femur（IFF） inelderly patients.Methods Fifty-four aged patients with IFF from Sep 2012 to Dec 2013 were retrospectively evaluated,including 28 cases underwent anatomical dynamic hip lock plate（ADHLP） and 26 cases underwent Dynamic hip screw（DHS）.The operative time,bloodloss,weight bearing time,hospitalstay,the healing time of fracture and postoperative 1 year Harris Hip scores were compared and statistically analyzed by SPSS19.0 statistical software.Results All cases were followed,the average duration was 14.6 months（range13 to 17 months）.Weight bearing time and fracture union in ADHLP group were shorter than that of DHS group（P〈0.05）.The blood loss,operativeduration,length of hospital stay showed no significant difference between the two groups（P〈0.05）.No significant difference were found in postoperative 1 year Harris score of hip joint function and the excellent and good rate between the two groups（P〈0.05）.The complication incidence of ADHLP group was significantly lower than DHS group after operation（P〈0.05）.Conclusion Compared to DHS fixation,ADHLP has shorter recovery stage for weight bearing time and shorter fracture union,lowercomplication incidence.ADHLP has more advantages than DHS in femoral intertrochanteric fractures of elderly patients,which is a preferable alternative.