导航下与传统方法应用动力髋螺钉治疗老年股骨转子问骨折的疗效比较  

A comparison of navigational and traditional dynamic hip screw fixations for intertrochanteric fractures in elderly patients

作　　者：李锋生[1] 陈瑞光[1] 梁伟国[1] 刘向荣[1] 叶冬平[1] 

机构地区：[1]暨南大学第四附属医院(广州市红十字会医院)骨科,广州510220

出　　处：《中华创伤骨科杂志》2009年第6期527-531,共5页Chinese Journal of Orthopaedic Trauma

基　　金：基金项目：广州市医药卫生重点项目（2008-ZDi-15）

摘　　要：目的比较导航下与传统方法应用动力髋螺钉（DHS）内固定治疗老年股骨转子间骨折的疗效。方法回顾性分析2005年4月至2007年4月期间接受导航下与传统方法应用DHS治疗且具有完整资料的56例老年股骨转子间骨折患者资料。导航下DHS内固定组（导航组）25例，骨折按Evans分型：Ⅰ型14例，Ⅱ型11例。传统DHS内固定组（传统组）31例，骨折按Evans分型：Ⅰ型16例，Ⅱ型15例。比较两组患者的切口长度、手术时间、术中出血量、术后卧床时间、X线暴露时间、内科并发症、3个月内骨折愈合率、内置物并发症及术后1年关节功能状况等。结果与传统组比较，导航组切口小、术中出血少、X线暴露时间少、术后卧床时间短及3个月内骨折愈合率较高，差异均有统计学意义（P〈0．05）。导航组23例患者术后获11～20个月（平均14个月）随访，2例失访。传统组30例患者术后获14～23个月（平均18个月）随访，1例因心血管意外而于1年内死亡。术后1年髋关节功能Harris评分：导航组（91．3％）优于传统组（73．3％），差异无统计学意义（P〉0．05）。导航组术后3例发生内科并发症，1例发生内置物并发症；传统组术后9例发生内科并发症，5例发生内置物并发症，两组间的并发症发生率差异无统计学意义（P〉0．05）。结论与传统DHS内固定治疗老年股骨转子间骨折比较，导航下DHS内固定具有切口小、术中出血量少、术后卧床时间短、骨折愈合快及术后髋关节功能恢复好等优点，值得在临床推广。Objective To compare the navigational and traditional dynamic hip screw （DHS） fixations in the treatment of intertrochanteric fractures in elderly patients. Methods A retrospective study was conducted to analyze the elderly patients with intertrochanterie fracture who had been treated in our department from April 2005 to April 2007 and whose clinical data were complete. Enrolled in the present study were 25 cases that had received navigational DHS fixation and 31 cases who had received traditional DHS fixation. In navigational group, there were 10 males and 15 females, with an average age of 82. 1 years. They were 14 cases of Evans type Ⅰ and 11 Evans type Ⅱ. In traditional group, there were 12 males and 19 females, with an average age of 82.8 years. They were 16 cases of Evans type Ⅰand 15 Evans type Ⅱ. The 2 groups were compared in incision length, operation time, bleeding volume, X-ray exposure time, bed-ridden time, medical and implant complications, and one-year functional recovery. Results In navigational group, 23 patients were followed for 11 to 20 （average, 14） months and 2 were lost. In traditional group, 30 patients were followed up for 14 to 23 （average, 18） months and 1 died from cardiovascular disease within 1 year. Compared with traditional group, navigational group had a smaller incision, less blood loss, shorter bed-ridden time and less X-ray exposure time, a higher rate of fracture healing at 3 months, with statistically significant differences （ P 〈 0.05）. The Harris hip function scores at postoperative 1 year were of no significant difference between the 2 groups （ P 〉 0. 05） . In navigational group there were 3 medical and 1 implant complications. In traditional group there were 9 medical and 5 implant complications. There was no significant difference between the 2 groups （ P 〉 0.05）. Conclusion In the treatment of intertrochanterie fractures for the elderly patients, the navigational DHS fixation is superior to traditional DHS fixation due to its advant

关 键 词：髋骨折 动力髋螺钉 外科手术 计算机辅助 老年人 

分 类 号：R686[医药卫生—骨科学]