髋前外侧C形入路与常规入路动力髋螺钉治疗老年股骨粗隆间骨折的对比研究

Comparison of fixation with dynamic hip screw by anterior lateral hip C-shaped approach and conventional approach in treatment of elderly femoral intertrochanteric fractures

目的对比髋前外侧C形入路与常规入路动力髋螺钉(DHS)治疗老年股骨粗隆间骨折的临床效果。方法回顾性分析于我院行DHS治疗的100例老年股骨粗隆间骨折患者的临床资料,依据手术入路将其分为常规入路组(n=46)和C形入路组(n=54)。比较2组患者手术相关指标,术前和术后3个月、6个月、12个月髋关节Harris评分,术后12个月髋关节功能及术后并发症情况。结果C形入路组手术时间、术中出血量、术中透视次数、引流量、住院时间均短/少于常规入路组(P<0.05)。2组患者术后3个月、6个月、12个月髋关节Harris评分均优于术前,且术后3个月、6个月、12个月髋关节Harris评分依次增高,差异均有统计学意义(P<0.05);术后各时间点C形入路组髋关节Harris评分优于常规入路组(P<0.05)。C形入路组术后12个月髋关节功能优良率高于常规入路组(P<0.05)。C形入路组术后并发症发生率低于常规入路组(P<0.05)。结论与常规入路相比,采用髋前外侧C形入路DHS治疗老年股骨粗隆间骨折患者创伤更小,有利于术后关节早期功能锻炼,促进髋关节功能恢复。

Objective To compare the clinical effect of fixation with dynamic hip screw(DHS)through anterior lateral hip C-shaped approach and conventional approach in the treatment of elderly femoral intertrochanteric fractures.Methods The clinical data of 100 patients with elderly femoral intertrochanteric fractures who received DHS treatment admitted to our hospital were retrospectively analyzed,and they were divided into the conventional approach group(n=46)and the C-shaped approach group(n=54)according to surgical approach.The operation related indexes,the Harris scores of hip joint before operation and 3 months,6 months and 12 months after operation,the hip joint function 12 months after operation and postoperative complications between the two groups were compared.Results The operation time,intraoperative blood loss,times of intraoperative fluoroscopy,volume of drainage and hospital stay of the C-shaped approach group were shorter/less than those of the conventional approach group(P<0.05).The Harris scores of hip joint in the two groups 3 months,6 months and 12 months after operation were better than those before operation,which increased successively with the time of 3 months,6 months,12 months after operation,the differences were statistically significant(P<0.05).The Harris scores of hip joint in the C-shaped approach group at each time point after operation were better than those in the conventional group(P<0.05).The excellent and good rate of hip function in the C-shaped approach group was higher than that in the conventional approach group 12 months after operation(P<0.05).The incidence of postoperative complications in the C-shaped approach group was lower than that in the conventional group(P<0.05).Conclusion Compared with the conventional approach,the fixation with DHS through the anterior lateral hip C-shaped approach in the treatment of elderly femoral intertrochanteric fractures has less trauma,which is conducive to early joint functional exercise after operation and can promote the recovery of hip joint function.