Intertan髓内钉和动力髋螺钉骨固定术治疗老年外侧壁不稳定型股骨转子间骨折的临床疗效

Clinical efficacy of two bone fixation methods of Intertan intramedullary nail and dynamic hip screw on elderly unstable lateral intertrochanteric femoral fractures

目的 对比Intertan髓内钉和动力髋螺钉(DHS)两种骨固定方式治疗老年外侧壁不稳定型股骨转子间骨折(IFF)患者的临床效果。方法 按骨固定方式将128例老年外侧壁不稳定型IFF患者分为Intertan组(n=65例)和DHS组(n=63例),比较两组患者围术期相关指标(切口长度、手术时间及术后失血量)及术后骨折愈合情况(骨痂形成时间、骨折愈合时间、术后下地活动时间、开始负重时间及住院时间);分别于术前、术后3个月及术后6个月时使用Harris髋关节评分系统评估两组患者的髋关节功能,并于术前、术后3个月使用血液流变仪检测两组血液流变学水平;随访6个月比较两组患者的并发症,同时使用Sanders髋关节创伤后功能评分量表评价两种骨固定方式的临床疗效。结果 Intertan组老年外侧壁不稳定型IFF患者切口长度、手术时间、术后骨痂形成时间、骨折愈合时间、下地活动时间、开始负重时间及住院时间均短于DHS组,术后失血量少于DHS组,差异有统计学意义(P<0.05);Intertan组患者术后3个月及术后6个月时髋关节功能恢复优良率均高于DHS组,差异有统计学意义(P<0.05);Intertan组患者术后3个月血浆黏度、全血黏度及红细胞比容均低于DHS组,差异有统计学意义(P<0.05);Intertan组与DHS随访期间并发症发生率比较,差异无统计学意义(P>0.05);术后6个月时,Intertan组优良率高于DHS组,差异有统计学意义(P<0.05)。结论 与DHS内固定术比较,Intertan髓内钉治疗外侧壁不稳定型IFF的效果较好,能够促进患者髋关节功能恢复。

Objective To compare the clinical effects of two bone fixation methods of Intertan intramedullary nail and dynamic hip screw( DHS) in treating elderly patients with unstable lateral intertrochanteric femoral fractures(IFF).Methods One hundred and twenty-eighty elderly patients with unstable lateral IFF were divided into Intertan group(n=65) and DHS group(n=63) according to the methods of bone fixation.The perioperative related indicators(incision length, surgical time and postoperative blood loss) and postoperative fracture healing( callus formation time, fracture healing time, postoperative ambulation time, time of starting weight-bearing and hospital stay) were compared between the two groups.Harris hip scoring system was used to evaluate the recovery of hip function before surgery, and 3 and 6 months after surgery respectively.After 6 month follow-up, the complications were compared, and Sanders hip post-traumatic function scale was adopted to assess the clinical efficacy of the two bone fixation methods.Results The incision length, surgical time,postoperative callus formation time, fracture healing time, ambulation time, time of starting weightbearing and hospital stay were all shorter in Intertan group than those in DHS group, and the intraoperative blood loss was less than that in DHS group(P< 0.05).The excellent and good rate of hip function recovery in InterTan group 3 and 6 months after surgery was higher than that in DHS group(P< 0.05).The plasma viscosity, whole blood viscosity and hematocrit in Intertan group were lower than those in DHS group 3 months after surgery(P< 0.05).There were no statistical differences in the incidence rates of complications during follow-up between Intertan group and DHS group(P>0.05).The excellent and good rate in Intertan group 6 months after surgery was better than that in DHS group(P< 0.05).Conclusion Compared with DHS internal fixation, Intertan intramedullary nail has better effects on the treatment of unstable lateral IFF, and can promote the recovery of hip function.