不同内固定方式治疗老年股骨转子间骨折疗效比较

Comparison the effects of various kinds of internal fixations for intertrochanteric fracture of femur in the elderly

目的探讨比较4种内固定方式治疗老年股骨转子间骨折(IFF)合并骨质疏松患者的疗效。方法回顾性分析上海交通大学附属第六人民医院急诊科自2015年12月至2017年11月收治的250例IFF合并骨质疏松的老年患者的临床资料。根据内固定方式不同将其分为股骨近端防旋髓内钉(PFNA-Ⅱ)组(n=137)、Gamma3髓内钉(TGN)组(n=35)、联合拉力交锁髓内钉(IN)组(n=38)与股骨近端锁定钢板(PFLP)组(n=40)。记录4组患者的围术期及预后情况,并比较其临床疗效。结果 IN组与PFLP组的手术时间均长于PFNA-Ⅱ组,PFNA-Ⅱ组与TGN组的术中出血量均低于IN组,差异均有统计学意义(P<0.05)。4组患者的住院总天数、术后全身和局部并发症发生率、术后1年病死率比较,差异均无统计学意义(P>0.05);PFLP组术后Harris髋关节功能评分(HHS)与髋部骨折功能恢复量表(FRS)评分均低于其他3组,差异有统计学意义(P<0.05)。Logistics回归结果显示,年龄和手术方式为影响HHS与FRS评分的相关因素,进一步年龄分组的单因素分析显示,4组患者在82~99岁阶段的HHS和FRS评分比较,差异无统计学意义(P>0.05)。结论对于IFF合并骨质疏松的老年患者,髓内固定比髓外固定更有利于髋部功能的恢复。

Objective To investigate and compare the efficacy of four internal fixation methods in the treatment of elderly patients with intertrochanteric fracture(IFF)combined with osteoporosis.Methods A retrospective study was performed on 250 cases of patients with IFF combined with osteoporosis who were admitted from December 2015 to November 2017.According to different divided into proximal femoral fixation way anti rotary intramedullary nailing(PFNA-Ⅱ)group(n=137),Gamma3 intramedullary nail(TGN)group(n=35),joint force/interlocking intramedullary nails(IN)group(n=38)and proximal femoral locking plate(PFLP)group(n=40).The perioperative period and prognosis of the 4 groups were recorded,and the clinical efficacy was compared.Results IN group with PFLP operation time was longer than PFNA-Ⅱ group,PFNA-Ⅱ group of intraoperative blood loss and the TGN group were lower than IN group,differences were statistically significant(P<0.05).The total number of days in hospital,the incidence of postoperative systemic and local complications,and the mortality at 1 year after surgery in the 4 groups showed no statistically significant differences(P>0.05).Postoperative Harris hip score(HHS) and functional recovery score(FRS) were lower in the PFLP group than in the other 3 groups,with statistically significant differences(P<0.05).Logistics regression showed that age and surgical method were related factors affecting HHS and FRS.One-Way ANOVA of further age groups showed no statistically significant differences in HHS and FRS between the four groups at ages 82 to 99(P>0.05).Conclusion For elderly patients with IFF and osteoporosis,intramedullary fixation is more beneficial to the recovery of hip function than extramedullary fixation.