高龄股骨转子间骨折三种手术方法的临床疗效分析  

Clinical outcomes of three treatments for intertrochanteric fracture in elderly patients

作　　者：胡艳辉[1] 向川[1] 段王平[1] 王斌[1] 王子江[1] 卫小春[1] 

机构地区：[1]山西医科大学第二医院骨科,太原030001

出　　处：《中国骨与关节外科》2012年第6期461-465,共5页Chinese Journal of Bone and Joint Surgery

基　　金：山西省自然基金(2010011050-2)

摘　　要：背景:股骨转子间骨折是老年常见骨折,临床以手术治疗为主,但高龄股骨转子间骨折患者手术内植物选择尚存争议。目的:探讨三种手术方法治疗高龄股骨转子间骨折的临床疗效。方法:2009年5月至2012年5月收治80岁以上股骨转子间骨折患者142例,其中包括动力髋螺钉(DHS)组45例、股骨近端防旋髓内钉(PFNA)组42例及人工股骨头置换(FHR)组55例,比较三组的术中出血量、术后部分负重时间、术后并发症及Harris髋关节功能评分等指标。结果:142例全部获得随访,随访时间5～40个月,平均21.4个月,死亡12例。术后并发症比较无统计学差异(P>0.05)。术中出血量:FHR组>DHS组>PFNA组,两两比较有统计学差异(P<0.05);术后部分负重时间:DHS组>PFNA组>FHR组,两两比较有统计学差异(P<0.05);Harris髋关节功能评分优良率:FHR组优于DHS组(P<0.05)。结论:DHS、PFNA及FHR治疗高龄股骨转子间骨折均有较满意疗效,相对于DHS和FHR,PFNA具有微创操作、出血少及固定可靠的优点,而FHR在临床疗效以及早期下地负重活动的优点更加明显,认为高龄股骨转子间骨折应以PFNA或FHR为首选。Background： Intertrochanteric fracture usually occur in the elderly and mainly treated by surgery. But the choice of implants is still controversial in elderly patients with intertrochanteric fracture. Objective： The aim of the present study is to explore the therapeutic effect of three methods in the treatment of intertrochanteric fracture in elderly patients. Methods： From May 2009 to May 2012, 142 elderly patients （over 80 years） with intertrochanteric fracture underwent surgical treatment with dynamic hip screw （DHS group, n=45）, proximal femoral nail antirotation （PFNA group, n=42）, and femoral head replacement （FHR group, n=55）. The clinical data including blood loss, time for partial weight-bearing after surgery, postoperative complications and Harris hip function score were compared among groups. Results： All the 142 patients were followed up. The average time of follow-up were 21.4 months （range from 5 to 40 months）. Twelve patients died during follow-up. Perioperativeblood loss： FHR group 〉 DHS group 〉 PFNA group （P〈 0.05）. Time for partial weight-bearing after surgery： DHS group 〉 PFNA group 〉 FHR group （P 〈 0.05）. Harris hip score in FHR group was significantly higher than DHS group （P 〈 0.05）. There was no significant difference in postoperative complications among groups （P〉 0.05）. Conclusions： The clinical results are satisfactory in the treatment of intertrochanteric fracture with DHS, PFNA and FHR for elderly patients. Compared with DHS and FHR, PFNA has a minimally invasive operation with less bleeding and better fixation. FHR has more advantages in weight-bearing ambulation. PFNA or FHR can be used as the first choice in the treatment of elderly intertrochanteric fracture.

关 键 词：转子间骨折 高龄 动力髋螺钉 股骨近端防旋髓内钉 人工股骨头置换 

分 类 号：R687.3[医药卫生—骨科学]