不同手术方法治疗老年骨质疏松性股骨转子间骨折的临床疗效比较研究

Comparative study of different surgical methods in the treatment of osteoporotic intertrochanteric fractures in the elderly

目的对比动力髋螺钉(DHS)内固定术与股骨近端防旋髓内钉(PFNA)内固定术治疗老年人股骨转子间骨折的临床疗效。方法选择2014年1月~2016年1月股骨转子间骨折老年患者60例作为研究对象,将其随机分成实验组和对照组,每组30例,对照组给予DHS治疗,实验组给予PFNA治疗,对两组患者的手术时间、切口长度、术中出血量、术中X线暴露次数、术引流量、术后下地时间和住院时间进行统计分析。比较两组术后并发症发生率。并对术后1年时采用Harris髋关节功能评分方法进行关节功能的评价。结果实验组手术时间、切口长度、术中X线暴露次数、术中出血量、引流量、术后下地时间、住院时间等方面明显少于对照组,差异有统计学意义(P<0.05);实验组患者术后并发症发生率为6.7%,显著低于对照组的20.0%,差异有统计学意义(χ~2=4.114,P<0.05);实验组的优良率为96.7%,高于对照组的93.3%,但差异无统计学意义(χ~2=0.345,P>0.05)。结论防旋股骨近端髓内钉内固定治疗老年人股骨转子间骨折的临床疗效显著优于人工关节置换,而且手术时间短、术中出血量少,能促进患者更好康复,值得临床推广和应用。

Objective To compare the efficacy of dynamic hip screw （DHS） internal fixation and proximal femoral intramedullary nail （PFNA） internal fixation in the treatment of intertrochanteric fractures in the elderly. Methods 60 elderly patients with intertrochanteric fractures from January 2014 to January 2016were selected. They were randomly divided into experimental group and control group, 30 patients in each group. DHS were treated in the control group. The experimental group was treated with PFNA. The operative time, incision length, intraoperative blood loss, intraoperative X-ray exposure, surgical drainage, postoperative time and hospitalization were analyzed statistically. The incidence of postoperative complications was compared between the two groups. The operative time, the length of incision, the number of intraoperative X-ray exposure, intraoperative blood loss, drainage volume, postoperative time, and time of operation were analyzed by Harris hip function score, at 1 year postoperatively. Results The operation time, incision length, the number of intraoperative X-ray exposure, the amount of bleeding during operation, the volume of drainage, the time after operation and the length of stay in the experimental group were significantly less than those in the control group, the difference was statistically significant （P 〈 0.05）. The incidence of postoperative complications was 6.7% in the experimental group, which was significantly lower than that in the control group （20.0%）, the difference was statistically significant, the difference was statistically significant （X2=4.114, P 〈 0.05）. The excellent and good rate oftbe experimental group was 96.7%, which was higher than that of the control group （93.3%）, but the difference was not statistically significant （X2=0.345, P 〉 0.05）. Conclusion The curative effect of anti-rotation femoral intramedullary nail fixation in the treatment of intertrochanteric fractures of the elderly is significantly better than that of artificial joint replacement, and the operation time is short and the intraoperative blood loss is small, which can promote the rehabilitation of patients and is worthy of clinical promotion And application.