不同内固定治疗方案在骨质疏松性股骨粗隆间骨折超高龄患者中的疗效比较

目的比较不同内固定方案治疗超高龄骨质疏松性股骨粗隆间骨折患者的疗效。方法选择2013年2月至2016年6月超高龄股骨粗隆间骨折患者164例，采用动力髋螺钉（DHS）治疗52例为DHS组，采用GammalII钉治疗54例为Gamma组，采用防旋型股骨近端髓内钉（PFNA）治疗58例为PFNA组，比较三组疗效。结果Gamma组平均手术时间（34．12±1102）min及PFNA组患者的平均手术时间（36．57±12．54）min显著低于DHS纽（62．31±23．51）min，Gamma组（5185％）和PFNA纽（51．72％）评价结果为“显效”的人数比例比DHS组患者（28．85％）高，而DHS组患者评价结果大多显示为“有效”。所以三种不同内固定方案对于超高龄骨质疏松性股骨粗隆间骨折患者均有治疗效果，但GammalII钉和防旋型股骨近端髓内钉治疗方案效果更加显著。结论三种不同内固定方案对于超高龄骨质疏松性股骨粗隆间骨折患者均有显著的治疗效果，三种方案对于稳定性骨折的治疗均有显著的治疗效果，GammalII钉及PFNA治疗方案对于不稳定性骨折效果更加显著。

Objective To explore the effect of different internal fixation on the treatment of osteoporotic intertrochanteric fracture in elderly patients. Methods 164 elderly patients from February 2013 to June 2016, with intertrochanteric fracture were treated in our hospital. The patients were divided into three groups according to the date of medical treatment, and different treatment internal fixation were adopted. Among them, the dynamic hip screw （ DHS ） in 52 cases of treatment group DHS was treated with GammalII nail treatment regimen of 54 cases were selected as Gamma group, the other 58 cases with anti rotation proximal femoral nail （ PFNA ） treatment group PFNA was recorded on the treatment ofperioperative three groups of patients were analyzed retrospectively and compared. Results The study found that the average operation time in group Gamma （ 34.12 ± 11.02 ） min and PFNA group of patients with the average operation time （ 36.57 ± 12.54 ） min was significantly lower than group DHS （ 62.31 ± 23.51 ） min, Gamma group （ 51.85% ） and PFNA group （51.72% ） evaluation results as the ＂effect＂ was more obvious than the proportion of patients in the DHS group （ 28.85% ） high, and the evaluation of patients in the DHS group results were shown as ＂effective＂. So three different internal fixation for treatment of osteoporotic femoral super aged patients with intertrochanteric fractures had therapeutic effect, but GammalII nail and proximal femoral antirotation intramedullary nail treatment had more significant effect, could effectively reduce the mortality of patients. Conclusion The three different internal fixation schemes have significant therapeutic effect on the patients with osteoporotic intertrochanteric fracture of the femur., GammaIII nail treatment scheme and PFNA treatment for unstable fracture effect are more significant.