不同定位方式下动力髋螺钉内固定治疗老年股骨转子间骨折的对比研究  

A retrospective trial of dynamic hip screw osteosynthesis using different positioning methods for intertrochanteric fractures of the femur in old patients

作　　者：胡月正[1] 温宏[1] 陈彩虹[1] 张宇[1] 

机构地区：[1]温州医科大学附属第二医院,浙江温州325027

出　　处：《中医正骨》2013年第6期14-19,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：浙江省温州市科技局科技项目(Y20110020)

摘　　要：目的:探讨不同定位方式下动力髋螺钉内固定术治疗老年股骨转子间骨折的临床疗效及安全性。方法:2003年4月至2009年12月,采用动力髋螺钉内固定治疗老年股骨转子间骨折患者95例,男48例,女47例;年龄65～87岁,中位数67岁;骨折AO分类:A1型30例,A2型65例。其中体外导向器定位动力髋螺钉固定30例,微型导向器定位动力髋螺钉固定33例,传统导向器定位动力髋螺钉固定32例。比较3组患者的切口长度、手术时间、术中失血量、术中X线透视次数、住院时间、血红蛋白检测值、术后疼痛程度评分、骨折愈合时间和患肢髋关节Harris评分。结果:95例患者均顺利完成手术,3组患者间切口长度[(3.7±0.6)cm,(4.4±0.4)cm,(8.5±1.7)cm]、手术时间[(59.2±13.2)min,(59.4±12.5)min,(88.4±12.3)min]、术中失血量[(35.3±9.9)mL,(37.2±9.7)mL,(347.2±87.7)mL]、术中X线透视次数[(13.7±1.4)次,(9.2±1.9)次,(5.0±0.8)次]、住院时间[(11.4±2.1)d,(10.8±2.1)d,(15.4±2.4)d]比较,差异均有统计学意义(F=176.344,P=0.000;F=65.394,P=0.000;F=386.554,P=0.000;F=282.202,P=0.000;F=41.804,P=0.000);体外导向器定位动力髋螺钉固定组与微型导向器定位动力髋螺钉固定组比较,切口长度、手术时间、术中失血量、住院时间的差异均无统计学意义(P=0.023,P=0.959,P=0.887,P=0.294),但前者的术中X线透视次数多于后者(P=0.000);体外导向器定位动力髋螺钉固定组与传统导向器定位动力髋螺钉固定组比较,前者的切口长度、手术时间、术中失血量、住院时间均短于(或少于)后者,术中X线透视次数多于后者(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000);微型导向器定位动力髋螺钉固定组与传统导向器定位动力髋螺钉固定组比较,前者切口长度、手术时间、术中失血量、住院时间均短于(或少于)后者,术中X线透视次数多于后者(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000)。术前3组患者间血红蛋白检测值[(125.8±7.2)g.L-1,(12Objective：To explore the clinical curative effects and safety of dynamic hip screw（DHS） osteosynthesis using different posi- tioning methods for intertrochanteric fractures of the femur in old patients. Methods： Ninety-five patients （48 males and 47 females） with intertrochanteric fractures of the femur, ranging in age from 65 to 87 years with a median of 67 years, were treated with DHS osteosynthesis between April 2003 and December 2009. According to AO fracture classification,30 patients were of A1 type, while 65 patients were of A2 type. Thirty patients were treated with extrasomatic guider DHS （EG-DHS）, 33 patients were treated with miniature guider DHS （MG- DHS） and 32 patients were treated with traditional guider DHS（TG-DHS）. The 3 groups were compared with each other in such parameters as incision length, operative time, blood loss, frequency of X-ray exposure, hospital stay, hemoglobin values, postoperative numerical rating scale （ NRS）, fracture healing time and Harris scores of hip joint. Results：The 95 patients underwent the operation successfully, and there were statistical differences among the 5 groups in the parameters as incision length [ （ 3.7 ± 0.6） cm, （4.4 ± 0.4） cm, （ 8.5 ± 1.7 ） cm ], op- erative time [ （59.2 ± 13.2 ） min, （59.4 ± 12.5 ） min, （ 88.4 ± 12.3 ） min ], blood loss [ （ 35.3 ± 9.9 ） mL, （ 37.2 ± 9.7 ） mL, （ 347.2 ± 87.7 ） mL ], frequency of X-ray exposure [ （ 13.7 ± 1.4 ）, （9.2 ~ 1.9 ）, （ 5.0 ± 0.8 ） ] and hospital stay [ （ 11.4 ± 2.1 ） d, （ 10.8 ± 2.1 ） d, （15.4 ± 2.4） d] respectively（ F = 176. 344,P =0. 000;F =65. 394,P =0. 000;F =386. 554,P =0. 000;F =282. 202,P =0. 000;F = 41. 804 ,P = 0. 000）. There were no statistical differences in incision length,operative time, blood loss and hospital stay between EG-DHS group and MG-DHS group respectively （P = 0. 023, P = 0. 959, P = 0. 887,P = 0. 294） ;while the frequency of X-ray exposure of the former group were more than tho

关 键 词：髋骨折股骨骨折骨折固定术 内 动力髋螺钉 

分 类 号：R687.3[医药卫生—骨科学]