三种手术方式治疗高龄骨质疏松性股骨转子间骨折疗效分析

Three kinds of surgical treatment of elderly osteoporotic intertrochanteric fractures compared

目的探讨治疗高龄骨质疏松性股骨转子间不稳定性骨折的方法及疗效。方法对119例高龄骨质疏松性股骨转子间不稳定骨折患者资料进行回顾性分析,其中GTF假体置换组38例,PFNA内固定组41例,DHS内固定组40例。3组患者年龄、性别、骨折类型、基础合并症差异无统计学意义(P>0.05)。通过门诊复查随访2年,观察手术时间、出血量、住院时间、术后下床活动时间、Harris评分、并发症和死亡率,对比分析三种方法在治疗高龄骨质疏松性股骨转子间不稳定骨折的差异。结果手术及住院时间,PFNA组<GTF假体组<DHS组;下床时间、并发症发生率和死亡率,GTF假体组<PFNA组<DHS组(P<0.05)。PFNA组出血量少(P<0.05);近期Harris评分,GTF假体组>PFNA组>DHS组(P<0.05),远期基本相同(P>0.05)。结论 PFNA内固定是治疗骨质疏松性股骨转子间不稳定骨折的理想方法,而GTF型假体置换对于粉碎性严重的骨质疏松性股骨转子间不稳定性骨折是一个不错的选择,但是DHS内固定应慎重选择。

Objective To investigate the therapeutic methodtreatment and the efficacyresult of elderly osteoporotic instability intertrochanteric fracture . Methods 119 cases of surgical elderly osteoporotic intertrochanteric fractures were analyzed by the retrospective study. Court to take greater trochanter shank type （GTF） prosthesis proximal femur intramedullary nail anti -rotation （PFNA） and dynamic hip screw （DHS） of 119 cases of surgical elderly osteoporotic intertrochanteric fractures in patients with unstable A retrospective study in which 38 patients accepted the greater trochanter shank type GTF prosthesis. The prosthesis proximal femur intramedullary nail anti - rotation （PFNA） group was 41 cases. The dynamic hip screw （DHS） group was 40 patients. Results In terms of the surgery and hospitalization time, PFNA group 〈 GTF prosthetic group 〈 DHS group,. But for the bed time, morbidity and mortality, GTF prosthesis 〈 PFNA group 〈 DHS group （P 〈 0.05 ） . PFNA group, hemorrhageless blood lessly loss （P 〈 0. 05 ） ; recent Harris score GTF prosthesis 〉 PFNA group 〉 DHS group in Harris score recently （P 〈 0. 05 ）, forward essentially the same （P 〉 0.05 ）. Conclusion GTF prosthesis for osteoporosis, and internal fixation of comminuted serious undesirable effects of intertrochanteric fracture instability is a good choice,but also the treatment of osteoporotic PFNA to unstable intertrochanteric fractures of the ideal method. However, DHS should be chosen carefully.