老年股骨粗隆间骨折不同治疗方式的对照分析  

A Comparison on Curative Effect of Different Methods in Treatment of Senile Femoral Intertrochanteric Fractures

作　　者：韩冠生[1] 张井泉[1] 李振伟[1] 陈辉[1] 

机构地区：[1]安徽省蚌埠医学院第二附属医院骨科,233040

出　　处：《中华全科医学》2011年第3期360-362,共3页Chinese Journal of General Practice

摘　　要：目的比较老年股骨粗隆间骨折不同治疗方式的临床疗效。方法 149例老年股骨粗隆间骨折患者,手术106例,动力髋螺钉(dynamic hip screw,DHS)38例,角钢板13例,外固定支架11例,髄内固定19例(包括Gamma钉、股骨重建钉(proximal femoral nail,PFN)等),股骨近端锁定加压接骨板(the locking compress plate,LCP)17例,人工股骨头8例,各组间一般资料比较,差异均无统计学意义(P>0.05)。结果随访(10.2±2.1)个月。手术组与未手术组在卧床时间、Harries评分及术后并发症上有差异有统计学意义(P<0.05)。外固定架和锁定钢板在切口长度、手术时间、术中出血、术后引流量与DHS、角钢板、髓内固定和人工股骨头差异有统计学意义(P<0.05)。卧床时间手术组大体相当,差异无统计学意义(P>0.05)。Harries评分及术后并发症,锁定钢板与外固定架比较差异有统计学意义(P<0.05)。结论手术治疗老年股骨粗隆间骨折疗效好,并发症少。LCP治疗股骨粗隆间骨折,手术固定牢固,创伤小,负重早,并发症少,尤其是粉碎性及骨质疏松性骨折的理想方法。Objective To evaluated the clinical effects of different methods in treating femoral intertrochanteric fracture in aged patients. Methods 106 cases were treated with dynamic hip screw（ DHS, 38 cases ）, angular plate （13 cases）, external fixator （ 11 cases）, Gamma or proximal femoral nail （ PFN, 19 cases ）, locking compress plat （ LCP, 17 cases） , artificial femoral head （ 8 cases） in 149 aged patients with femoral intertrochanteric fracture. There were no significant difference in general data between all groups （ P 〉 0.05 ）. Results All the cases were followed up for 10.2 ＋ 2.1 months. Surgical and non-surgical groups were signif- icant differences in out-of-bed time, the Harris hip score and after operative complications （ P 〈 0.05 ）. There were significant difference between the external fixator and LCP group and the other four groups（ DHS;angular plate;Gamma or PFN and artificial femoral head） in the incision length, operation time, blood loss and drainage （P 〈 0.05 ）. There were no significant difference in out-of-bed time in surgical groups（P 〉 0.05 ）. LCP and the external fixator groups were significantly different in the Harris hip score and after operative complications （ P 〈 0.05 ）. Conclusion The operative treatment had some superiority. LCP was the best internal fixation device for femoral intertrochanteric fractures in the aged people, its advantage was simple manipulation, shorter operative time and clinical healing time, firmer fixation and fewer blood loss and LCP for type IV/1V fracture was also a satisfactory method.

关 键 词：老年粗隆间骨折 动力髋螺钉(DHS) 锁定加压接骨板 Gamma或股骨近端钉(PFN) 

分 类 号：R683.421[医药卫生—骨科学]