髋前外侧C形入路治疗老年股骨粗隆间骨折疗效分析  

EFFECTIVENES OF ANTEROLATERAL C-SHAPED APPROACH IN TREATMENT OF INTERTROCHANTERIC FRACTURE OF FEMUR IN ELDERLY PATIENT

作　　者：吴炳华[1] 戴闽[2] 邹帆[2] 张斌[2] 李斌华[2] 骆松[2] 邱平[2] 

机构地区：[1]南昌大学第四附属医院骨科,南昌330006 [2]南昌大学第一附属医院骨科

出　　处：《中国修复重建外科杂志》2013年第8期985-989,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：江西省卫生厅科技计划资助项目(20131097)~~

摘　　要：目的通过与传统髋外侧入路比较,探讨髋前外侧C形入路治疗老年股骨粗隆间骨折的疗效。方法回顾分析2010年4月-2011年11月66例采用动力髋螺钉(dynamic hip screw,DHS)治疗的老年股骨粗隆间骨折患者临床资料,其中采用髋前外侧C形入路37例(改良组),髋外侧入路29例(常规组)。两组患者性别、年龄、致伤原因、侧别、病程、骨折分型及合并症比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间、术中出血量、术后引流量、住院时间,复查X线片观察骨折愈合情况,根据自定疗效评定标准评定髋关节功能。结果两组均顺利完成手术,术后切口均Ⅰ期愈合。患者均获随访,随访时间12～24个月,平均17.8个月。患者骨折均达骨性愈合,愈合时间3～6个月,平均4.8个月。随访期间无内固定物松动、断裂发生。与常规组相比,改良组患者手术时间明显缩短,术后引流量显著减少(P<0.05);而术中出血量及住院时间比较差异均无统计学意义(P>0.05)。术后6、12个月根据自定评价标准,改良组髋关节屈伸活动恢复程度及功能评定结果均优于常规组,比较差异有统计学意义(P<0.05)。结论髋前外侧C形入路联合DHS治疗老年股骨粗隆间骨折,对肌肉损伤小,减少了肌纤维大量破坏所造成的瘢痕形成,有利于手术暴露及术后早期功能康复锻炼。Objective To study the effectiveness of anterolateral C-shaped approach in the treatment of intertrochanteric fracture of the femur in elderly patient by comparing with traditional anterolateral approach. Methods Between April 2010 and November 2011,66 patients with intertrochanteric fracture of the femur were analyzed retrospectively.Of 66 patients,37 underwent improved anterolateral C-shaped approach combined with fixation of dynamic hip screw（DHS）（improved group）,and 29 underwent traditional anterolateral approach combined with fixation of DHS（conventional group）.There was no significant difference in gender,age,injury cause,side,disease duration,fracture type,and complication between 2 groups（P 0.05）.The operation time,intraoperative blood loss,postoperative drainage volume,and hospitalization time were recorded;and X-ray films were taken to observe the fracture healing.The hip function was evaluated according to self-established criterion. Results The operation was successfully completed in all patients,and primary healing of incision was achieved.All patients were followed up 12-24 months（mean,17.8 months）.Bone union was achieved in both groups;the fracture healing time was 3-6 months（mean,4.8 months）.No loosening or breaking of internal fixation was observed during follow-up period.The operation time and postoperative drainage volume of improved group were significantly less than those of conventional group（P 0.05）;no significant difference was found in intraoperative blood loss and hospitalization days between 2 groups（P 0.05）.According to self-established criterion,improved group was significantly better than conventional group in recovery of hip joint motion and function at 6 and 12 months after operation（P 0.05）. Conclusion Anterolateral C-shaped approach combined with DHS could minimize muscle injury and scar formation,which is beneficial to surgical exposure and early postoperative rehabilitation.

关 键 词：髋前外侧C形入路 股骨粗隆间骨折 动力髋螺钉 老年患者 

分 类 号：R687.3[医药卫生—骨科学]