微创治疗老年不稳定股骨转子间骨折伴骨质疏松症的回顾性研究

Minimally invasive treatment of femoral intertrochanteric fracture in osteoporotic elderly patients: A retrospective study

目的探讨微创内固定治疗老年骨质疏松不稳定股骨转子间骨折的方法及疗效。方法回顾性分析2009年1月-2015年9月采用Intertan或短重建钉(TAN)内固定微创治疗的112例老年性骨质疏松股骨转子间骨折患者的临床资料。所有患者均结合病史、查体及影像学检查进行诊断,按照AO分型,31-A.1型34例,31-A.2型61例,31-A.3型17例。对手术时间、透视时间、术中失血量、住院天数、并发症及髋关节功能评分等进行统计分析。结果 112例患者中78例获随访,随访时间3~27个月(平均15个月),其中Intertan组41例,TAN组37例。Intertan组手术时间、透视时间(分别为58.9±6.9、2.70±0.47min)明显短于TAN组(分别为75.6±5.9、4.40±0.47min),术中出血量(107.6±6.7ml)明显低于TAN组(127.8±6.8ml),髋关节Harris评分优良率(73%)高于TAN组(65%),术后并发症发生率(4.9%)低于TAN组(10.8%),差异均有统计学意义(P<0.05)。两组住院天数、骨折愈合时间比较差异无统计学意义(P>0.05)。结论Intertan和TAN两种微创固定方法治疗不稳定股骨转子间骨折均可取得较好的临床疗效,其中Intertan具有操作简单、固定可靠、出血少、髋关节功能恢复好、并发症少等优点,是治疗老年骨质疏松不稳定股骨转子间骨折的良好选择。

Objective To evaluate the clinical outcomes of minimally invasive internal fixation for femoral intertrochanteric fracture in osteoporotic elderly patients. Methods A retrospective study was conducted in 112 patients using interan nail （IN） or trochanteric antegrade nail （TAN） for the management of intertrochanteric femoral fracture from January 2009 to September 2015 in our hospital. According to AO classification, there were 34 cases of type 31-A.1, and 61 cases of type 31-A.2, 17 cases of type 31-A.3. Clinical and radiological follow-up were available. Surgical and fluoroscopic time, length of hospital stay, blood loss, complications and hip functions were compared between two groups. Results A total of 78 patients meeting the criteria were evaluated at a mean follow-up of 15 months （range, 3-27 months）. The IN was used in 41 patients and the TAN in 37 patients. Operative time, fluoroscopy time and blood loss showed significant difference between the IN group and TAN group （respectively, 58.9±6.9 vs. 75.6±5.9min; 2.70±0.47 vs. 4.40±0.47min; 107.6±6.7 vs. 127.8±6.8ml, P〈0.05）, suggesting that patients treated with the IN experienced shorter operative and fluoroscopy times, less blood loss and better hip function （73%） than those with TAN （65%, P〈0.05）. Rate of postoperative complications was lower in the IN group （4.9%） than in the TAN group （10.8%, P〈0.05）. There was no difference in hospital stay and fracture healing time between the two groups （P〉0.05）. Conclusions For minimally invasive treatment of unstable femoral intertrochanteric fractures, use of either the IN or TAN is clinically effective. However, IN presents more advantages （e.g., easy operation, reliable fixation, less bleeding, better clinical outcomes, and less complications）. The use of IN is a suitable option for the treatment of unstable intertrochanteric fractures in osteoporotic elderly patients.