老年股骨粗隆间骨折不同内固定手术疗效分析  

The Effect of Different Ways of Internal Fixation in Treatment of Elderly Patients with Femoral Intertrochanteric Fracture

作　　者：陆晓涛[1] 侯开宇[1] 张伟[1] 李勇刚[1] 

机构地区：[1]云南省第二人民医院骨科,云南昆明650021

出　　处：《昆明医科大学学报》2013年第4期118-121,共4页Journal of Kunming Medical University

摘　　要：目的探讨不同内固定手术治疗股骨粗隆间骨折的疗效.方法回顾分析2005年1月至2012年12月收治老年股骨粗隆间骨折179例,根据不同类型手术,分别采用动力髋螺钉(dynamic hip screw,DHS)、伽马钉(Gamma screw)、股骨近端髓内钉(proximal femoral nail,PFN)、股骨近端防旋髓内钉(proximal femoralnail-antirotation,PFNA)进行治疗,比较各组手术时间、术中失血量、骨折愈合时间、术后关节功能恢复、术后并发症等情况.结果随访179例病例,随访时间21 d～6 a,平均34个月.比较4组内固定术患者手术时间、术中失血量、术后关节功能恢复的优良率差异有统计学意义(P<0.05);PFNA组骨折愈合时间较其他组短,但与Gamma、PFN组比较无统计学差异;手术后并发症DHS、Gamma组髋内翻分别为2例、1例,DHS、Gamma、PFN组头钉切割各1例,PFNA组无并发症.结论 4种内固定手术各有优缺点,术前应根据患者病情、基础疾病、骨折类型、是否有合并伤,合理选择内固定,但PFNA组骨折愈合时间较其他组短,手术效果较其余3组有明显的优势,应尽量选用PFNA对老年人股骨粗隆间骨折进行治疗.Objective To explore the effect of the different ways of internal fixation in treatment of elderly patients with femur intertrochanteric fractures. Methods 179 elderly femur intertrochanteric fractures patients were retrospectively analyzed from January 2005 to December 2012. The patients were divided into four groups and given four different operations of internal fixation by using dynamic hip screw Gamma screw proximal femoral nail and proximal femoral nail respectively. The operative time blood loss fracture healing time postoperative joint function recovery postoperative complications were compared among the four groups. Results 179 patients were followed up for 21 days to 6 years with an average of 34 months. The healing time of the group of PFNA is shorter than the other groups but there was no statistically significant difference. The postoperative complications of Coxa vara were found in two cases and one case for the group of DHS and the group of Gamma respectively. And there all had one case of brad cutting for the group of DHS the group of Gamma and the group of PFN. However there was no complication in the group of PFNA the difference was statistically significant （P 〈 0.05） Conclusions Four internal fixation operations have advantages and disadvantages and should be reasonably choosed based on the patient＇s condition before surgery underlying diseases type of fracture and its associated injury. However the fracture healing time of the group of PFNA is shorter than the other groups and has better effect so PFNA should be used in treatment of elderly femur intertrochanteric fractures as well as possible.

关 键 词：老年人 股骨粗隆间骨折 骨折 内固定术 疗效 

分 类 号：R683[医药卫生—骨科学]