3种动力髋螺钉固定方式治疗骨质疏松性股骨粗隆间骨折的比较研究  

Comparative studies of three methods of DHS internal fixation for the treatment of osteoporotic intertrochanteric fracture

作　　者：王斌[1] 吕浩然[2] 王伟雄[1] 李燊[2] 

机构地区：[1]广州医科大学附属第二医院急诊外科,510260 [2]广州医科大学附属第二医院骨科,510260

出　　处：《中国骨科临床与基础研究杂志》2013年第6期325-330,共6页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省科技计划项目(2010B031100029)

摘　　要：目的：比较单纯动力髋螺钉（DHS）内固定、骨水泥强化联合DHS内固定以及异体人工骨主钉道植骨配合DHS内固定3种术式治疗老年性骨质疏松股骨粗隆间骨折的疗效差别。方法采用随机数字表法将2010年1月至2012年9月广州医科大学附属第二医院收治、符合病例选择标准的90例老年骨质疏松性股骨粗隆间患者随机分入单纯DHS内固定组（对照组）、骨水泥强化联合DHS内固定组（骨水泥组）和异体人工骨主钉道植骨配合DHS内固定组（植骨组），每组30例。比较3组术后Harris髋关节功能评分优良率、骨折愈合时间及术后并发症发生率的差异。结果90例患者均获完整随访，随访时间12～18个月（平均14.8个月）。植骨组、骨水泥组和对照组术后Harris功能评分优良率分别为93%、80%、70%，植骨组明显优于对照组（P＜0.05）；与对照组、骨水泥组比较，植骨组骨折愈合时间明显缩短（P＜0.05）；3组中植骨组并发症发生率最低（3%），远低于对照组和骨水泥组（27%和10%）。结论异体人工骨主钉道植骨配合DHS内固定治疗老年性骨质疏松股骨粗隆间骨折具有髋关节功能恢复好、骨折临床愈合时间短、并发症少等优点，临床效果满意。Objective To compare the differences of clinical efficacy among 3 surgical methods for treatment of osteoporotic intertrochanteric fracture including conventional dynamic hip screw （DHS） fixation, bone cement augmentation with DHS fixation as well as allogeneic bone grafting with DHS fixation. Methods According to random number table, 90 elderly patients with osteoporotic intertrochanteric fracture treated in the Second Affiliated Hospital of Guangzhou Medical College from January 2010 to September 2012 were divided＆nbsp;randomly into control group, bone cement group and bone grafting group, in which preformed DHS fixation, bone cement augmentation combined with DHS fixation, and allogeneic bone grafting with DHS fixation respectively. Differences of excellent and good rate of postoperative Harris score, time of fracture healing and the incidence of postoperative complications were compared among 3 groups. Results All patients were followed-up for 12 to 18 months, with the average of 14.8 months. Excellent and good rate according to Harris score was 93%, 80% and 70% in bone grafting group, bone cement groups and control group respectively, which showed the difference between control group and bone grafting group （P〈0.05）. Compared with control group and bone cement group, time of fracture healing in bone grafting group was shorter （P 〈0.05）, and the incidence of postoperative complications （3%） was the lowest （27%, 10% in control and bone cement group respectively）. Conclusions For elderly patients with osteoporotic intertrochanteric fracture, allogeneic bone grafting combined with DHS fixation may get satisfied clinical effect because of its advantages of good postoperative hip joint function rehabilitation, short fracture healing time, and less complications.

关 键 词：股骨骨折 骨质疏松 骨折固定术 内 骨螺钉 骨移植 移植 异种 骨代用品 骨水泥 

分 类 号：R687.3[医药卫生—骨科学]