剪刀体位下标准γ-Ⅲ型髓内钉和DHS治疗老年股骨转子间骨折的疗效分析

Therapeutic Effect of Standard γ-Ⅲ Intramedullary Nail and DHS in the Treatment of Senile Intertrochanteric Fractures

目的探讨剪刀体位下标准γ-Ⅲ型髓内钉与动力髋螺钉治疗老年股骨转子间骨折的临床疗效分析。方法回顾性分析自2013年1月—2017年8月间应用动力髋螺钉(DHS)和剪刀体位下的标准γ-Ⅲ型髓内钉(γ-Ⅲ standard interlocking intramedullary nail)治疗老年患者的股骨转子间骨折共86例,其中标准γ-Ⅲ型髓内钉44例,DHS组42组例。比较两组的手术时间、术中出血量、术中X线曝光次数、末次随访髋关节Harris评分情况。结果两组患者手术均取得良好的手术效果,标准γ-Ⅲ型髓内钉组在手术时间(t=4.8 P=0.003)、术中出血量(t=7.86,P=0.024)、术中X线曝光次数(χ^2=6.32,P=0.043)差异有统计学意义(P<0.05)。但术后末次随访髋关节Harris评分上差异无统计学意义(t=5.10,P=0.13)。结论标准γ-Ⅲ型髓内钉和DHS治疗老年股骨转子间骨折均取得良好临床效果,但剪刀体位下的标准γ-Ⅲ型髓内钉术更适合骨质疏松、关节活动度差的老年患者,具有手术时间短,手术创伤小,术中出血少,术中X线透视次数少,患者术后下床活动早,恢复快等明显优点。

Objective To investigate the clinical efficacy of standard γ-Ⅲ intramedullary nail and dynamic hip screw in the treatment of intertrochanteric fractures in the elderly. Methods Retrospective analysis of femoral trochanter in elderly patients from January 2013 to August 2017 using dynamic hip screw(DHS) and γ-Ⅲ standard interlocking intramedullary nail. There were 86 cases of inter-fracture, including 44 cases of standard γ-III intramedullary nail and 42 cases of DHS group. The operation time, intraoperative blood loss, intraoperative X-ray exposure, and hip Harris score at the last followup were compared between the two groups. Results The operation of the two groups of patients achieved good surgical results. The standard γ-Ⅲ intramedullary nail group was used during operation time(t=4.8, P=0.003), intraoperative blood loss(t=7.86, P=0.024), intraoperative X-ray exposures(χ~2= 6.32,P=0.043) was statistically significant(P<0.05). However,there was no significant difference in hip Harris score at the last follow-up(t=5.10,P=0.13). Conclusion Standard γ-Ⅲ intramedullary nail and DHS have good clinical results in the treatment of intertrochanteric fractures in the elderly. However,standard γ-Ⅲ intramedullary nailing in the position of scissors is more suitable for elderly patients with osteoporosis and poor joint mobility. It has the advantages of short operation time, small surgical trauma, less intraoperative blood loss, fewer intraoperative X-rays, early post-operative activities, and quick recovery.