不同手术方法治疗老年股骨粗隆间骨折疗效分析  

Efficacy analysis of different surgical methods in treating senile femoral intertrochanteric fractures

作　　者：沈宁江[1] 宋世锋[1] 王广积[1] 林坚平[1] 黎早敏[1] 林明侠[1] 林庆彪[1] 

机构地区：[1]海南省人民医院骨科中心,海口市570311

出　　处：《中国骨与关节损伤杂志》2013年第10期914-916,共3页Chinese Journal of Bone and Joint Injury

基　　金：海南省自然科学基金项目(809048)

摘　　要：目的比较动力髋螺钉(DHS)、解剖型锁定钛板(LCP)内固定和加长柄双极人工股骨头置换术治疗老年股骨粗隆间骨折的疗效。方法 454例老年股骨粗隆间骨折采用DHS内固定182例,LCP内固定201例,人工股骨头置换71例。结果 DHS、LCP、人工股骨头置换组手术时间相当,差异无统计学意义(P>0.05);内固定组(DHS、LCP组)术中出血量、卧床时间相当,差异无统计学意义(P>0.05),但术中出血量少于人工股骨头置换组,卧床时间明显长于人工股骨头置换组,差异均有统计学意义(P<0.05);末次随访Harris评分优良率DHS组明显低于LCP、人工股骨头置换组,差异均有统计学意义(P<0.05)。结论 LCP是治疗老年股骨粗隆间骨折比较理想的内固定方式,人工股骨头置换术也是一种正确的选择,但适用于75岁以上不稳定且合并重度骨质疏松骨折。Objective To compare the efficacy of dynamic hip screw （DHS）, anatomical locking compression plate （LCP） and long-stem bipolar hemiarthroplasty in the treatment of senile femoral intertrochanteric fractures. Methods A total of 454 elderly patients with femoral intertrochanteric fracture underwent surgery. Of which, 182 cases were treated with DHS, 201 cases with LCP and 71 cases with hemiarthroplasty. Results The averaged operative time was similar in three groups, and the difference was not statistically significant（P 〉0.05）. Blood loss and bed rest time was similar in the internal fixation group（DHS, LCP group）, with no statistically significant difference （P 〉0.05）. Compared with hemiarthroplasty, the internal irLxation group （DHS, LCP group） had less blood loss and significantly longer bed time rest, the differences were statistically significant （P 〈 0.05）. According to Harris assessment criteria, at final follow-up time, the excellent and good rate of DHS group was obviously lower than the LCP and hemiarthroplasty group, the differences were statistically significant （P 〈0.05）. Conclusion LCP is an ideal internal fixation method in treating senile femoral intertrochanteric fractures. Hemiarthroplasty is also a correct choice, but applies to patients elder than 75 years with unstable fracture type and severe osteoporosis.

关 键 词：股骨粗隆间骨折 内固定 DHS LCP 双极人工股骨头置换术 老年 

分 类 号：R687.42[医药卫生—骨科学] R687.32[医药卫生—外科学]