InterTan髓内钉治疗老年股骨转子间冠状位骨折的病例对照研究

Case control study on Inter Tan intramedullary nail in treating coronal femoral intertrochanteric fracture in elderly

目的 ：比较闭合复位与有限切开复位结合Inter Tan髓内钉内固定治疗老年股骨转子间冠状位骨折的临床疗效。方法：自2013年1月至2015年12月,回顾性分析手术治疗的23例老年股骨转子间冠状位骨折患者,根据复位方式不同分为两组。闭合复位Inter Tan髓内钉内固定组12例（闭合复位组）,男7例,女5例,平均年龄（63.6±12.1）岁;有限切开复位Inter Tan髓内钉内固定组11例（切开复位组）,男6例,女5例,平均年龄（60.8±12.5）岁。观察并比较两组患者的术中出血量、术中透视次数、手术时间、术后并发症、住院时间、骨折愈合时间,术后1年采用髋关节Harris功能评分进行对比。结果：两组切口均Ⅰ期愈合,无手术并发症。闭合复位组1例患者随访期间死亡,共22例患者（闭合复位组和切开复位组各11例）术后获随访,时间12~23个月,平均13.6个月。两组患者手术时间、术中出血量、透视次数比较差异均有统计学意义（P〈0.05）;而两组患者的住院时间、术后并发症比较差异均无统计学意义（P〉0.05）。切开复位组术后1年髋关节Harris功能评分为83.9±8.9,闭合复位组为83.4±9.1,两组比较差异无统计学意义（P〉0.05）。结论 ：闭合复位与有限切开复位结合Inter Tan髓内钉内固定治疗股骨转子间冠状位骨折都可以取得良好的临床疗效,前者患者及术者需要接受较多的辐射剂量,但对患者创伤小;后者术中出血量相对较多、手术时间较长,但复位质量高。

Objective：To compare clinical effect of closed reduction and limited open reduction and internal fixation with Inter Tan intramedullary nail in treating elderly patients with coronal femoral intertrochanteric fracture. Methods：From January2013 to December 2015,23 elderly patients with coronal femoral intertrochanteric fracture were divided into two groups according to different ways of reduction to be retrospectively analyzed. There were 12 cases with closed reduction and internal fixation with Inter Tan intramedullary nail group（closed reduction group）,including 7 males and 5 females with an average age of（63.6 ±12.1） years old;while 11 cases with limited open reduction and internal fixation with Inter Tan intramedullary nail group（limited reduction group）,including 6 males and 5 females with an average of（60.8 ±12.5） years old. Intraoperative blood loss,fluoroscopy,operative time,postoperative complications,hospital stays and bone healing time were observed and compared. Harris score of hip joint at 1 year after operation was compared between two groups. Results：The incisions between two groups were healed well at stage Ⅰ,and no complications occurred. One case was died during following up,and 22 cases were obtained following up from 12 to 23 months with an average of 13.6 months. There were significant difference in operative time,intraoperative blood loss and fluoroscopy（P〈0.05）;while no difference in hospital stays,postoperative complications（P〉0.05）. Harris score at 1 year after operation in open reduction group was（83.9±8.9）,and（83.4±9.1） in closed reduction group without significant difference between two groups（P〉0.05）. Conclusion：Closed reduction and limited open reduction with Inter Tan intramedullary nail internal fixation for the treatment of intertrochanteric femoral coronal fractures could achieve good clinical effects,the former to receive more radiation dose,with less trauma;while the latter has disadvantages of long blood bleeding and operative time,but could obtain high quality of reduction.