经皮加压钢板与动力髋螺钉治疗老年股骨粗隆间骨折的对照研究  

Percutaneous compression plate vs dynamic hip screw fixation in treatment of intertrochanteric hip fractures in elderly patients

作　　者：沈杰[1] 黄强[1] 谢肇[1] 王序全[1] 马树枝[1] 许建中[1] 

机构地区：[1]第三军医大学西南医院骨科,全军矫形外科中心,重庆400038

出　　处：《第三军医大学学报》2013年第19期2095-2100,共6页Journal of Third Military Medical University

摘　　要：目的探讨经皮加压钢板（ percutaneous compression plate, PCCP）与动力髋螺钉（dynamic hip screw，DHS）治疗老年骨质疏松性股骨粗隆间骨折的临床疗效并进行对比分析。方法对2008年1月至2011年6月在我院采用PCCP和DHS内固定治疗且获得随访的年龄≥60岁的股骨粗隆间骨折患者的病历资料进行回顾性分析。DHS组67例，包括男性27例，女性40例，年龄60～106岁，平均81．3岁。按AO分型，A1型17例，A2型43例，A3型7例。PCCP组76例，包括男性30例，女性46例，年龄61-100岁，平均80．7岁。按AO分型，A1型20例，A2型47例，A3型9例。对手术时间、术中出血量、术后输血量、术后血红蛋白下降值、住院时间、骨折愈合时间、Harris髋关节功能评分、颈干角变化等情况进行对比分析。结果PCCP组和DHS组患者在年龄、性别、骨折分型、术前ASA评分、术后输血量等方面的差异无统计学意义（P〉0．05）。PCCP组较DHS组在手术时间[（50．45±16．22）min vs（76．04±13．30）min]、术中出血量[（43．33±16．49）mL vs（240．00±108．56）mL]、术后血红蛋白下降值[（12．38±5．37）g／Lvs（15．73±5．80）g／L]、住院时间[（9．95±4．13）d vs（16．15±6．34）d]明显下降（P〈0．05）。术后随访12-28个月，平均17个月，骨折愈合时间2组无明显差异（P〉0．05），但PCCP组在Harris髋关节功能评分、颈干角变化等明显优于DHS组（P〈0．05）。结论PCCP治疗老年骨质疏松性股骨粗隆间骨折具有微创、稳定等优点，在手术创伤、功能恢复等方面优于DHS。Objectve To compare the clinical efficiency of percutaneous compression plate （PCCP） and dynamic hip screw （DHS） in the treatment of osteoporotic intertrochanteric femoral fractures in elderly patients. Methods A retrospective study was carried out on 143 elderly patients with intertrochanteric femoral fractures undergoing PCCP or DHS in our center from January 2008 to June 2011. Sixty-seven patients, 27 males and 40 females, with an average age of 81.3 （ranging from 60 to 106） were treated with DHS, including 17 cases of type A1,43 cases of type A2 and 7 cases of type A3. Another 76 patients, 30 males and 46 females with an average age of 80.7 （ranging from 61 to 100）, were treated with PCCP, including 20 cases of type A1, 47 cases of type A2 and 9 cases of type A3. The operation time, blood loss, hemoglobin decrease, blood trans- fusion, hospitalization time, fracture healing, Harris score of the hip joint and changes in neck-shaft angle were observed and compared in the 2 groups. Results There was no significant difference between the PCCP group and DHS group in the age, gender, fracture type, pre-operative ASA score and blood transfusion （P 〉 0.05 ）. The average operating time （50.45 ± 16.22 vs 76.04 ± 13.30 min）, intra-operative blood loss （43.33 ± 16.49 vs 240.00 ± 108.56 mL）, hemoglobin decrease （ 12.38 ±5.37 vs 15.73 ±5.80 g/L）, and hospitalization time （9.95 ±4.13 vs 16.15 ±6.34 d） was significantly lower in PCCP group than DHS group（P 〈0.05）. All patients were followed up for more than an average of 17 months （ranging from 12 to 28 months）. No statistically significant difference was found in fracture healing between the 2 group （P 〉 0.05 ）. But PCCP group was superior to DHS group in Harris hip score and changes in neck-shaft angle （P 〈 0.05）. Conclusion PCCP isan approach of stable efficiency and minimal invasion in the treatment for osteoporotic intertrochanteric hip fractures, and superior to DHS in operative trauma and function rec

关 键 词：股骨粗隆间骨折 老年 经皮加压钢板 动力髋螺钉 

分 类 号：R339.34[医药卫生—人体生理学] R687.3[医药卫生—基础医学]