老年股骨转子间骨折不同治疗方法的评价  

The evaluation of different surgeries on femoral intertrochanteric fracture in elderly patients

作　　者：陈述祥[1] 刘彦[1] 陈丽君[1] 

机构地区：[1]暨南大学医学院附属江门中医院骨科,广东江门529031

出　　处：《暨南大学学报（自然科学与医学版）》2014年第2期177-181,共5页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：广东省江门市科技计划项目(江科[2009]75-5)

摘　　要：目的：比较髓外固定系统，髓内固定系统及人工股骨头置换治疗老年股骨转子间骨折疗效．方法：将220例股骨转子间骨折资料完整的患者分动力髋螺钉（DHS）组、股骨近端防旋髓内钉（PFNA）组、人工股骨头置换组（HHA）进行回顾性分析，其中DHS组82例、PFNA组68例、人工股骨头置换组70例．男性92例，女性128例，年龄70～101岁，平均79.8岁，骨折按Jensen-Evans分型：Ⅰ型22例、Ⅱ型51例、Ⅲ型78例、Ⅳ型44例、Ⅴ型20例、R型（逆粗隆型）5例．比较三组患者术前情况、手术时间、术中出血量、术后下地时间和完全负重时间、骨折愈合时间、患髋功能及并发症等．结果：术后患者获得8～24个月随访，平均13个月．三组疗效满意，优良率比较差异无显著性意义（P＞0.05），三组患者在性别、年龄、骨折类型、内科合并症方面差异无显著性意义．手术时间与术中出血量：PFNA组与DHS组及人工股骨头置换组、PFNA、DHS组比较具有统计学意义（P＜0.05）．PFNA手术时间最短，术中出血量最少，人工股骨头置换组手术时间最长，术中出血量最多，DHS组居中．术后下地时间和完全负重时间：人工股骨头置换组与PFNA组、DHS组、PFNA组与DHS组比较具有统计学意义（P＜0.05）；术后骨折愈合时间PF-NA组与DHS组比较无统计学意义．术后并发症29例（13.2％）．人工股骨头置换组Harris评分最高，差异有统计学意义．结论：三种方法均可以有效的治疗老年股骨转子间骨折，但应根据年龄、身体状况、骨质疏松情况、骨折类型等进行综合评估．对于不稳定型并有严重疏松且不能耐受关节置换术者，髓内固定为首选；对于高龄不稳定骨折，严重骨质疏松，术前可行走，能耐受一次较大手术者可首选人工股骨头置换．而对骨折稳定、骨质疏松不严重、身体状况较好者，也可选用DHS髓�Aim：To compare the clinical efficacy of extramedullary fixation system,intramedullary fix-ation system and hemi-hip arthroplasty in treatment of intertrochanteric fractures in the elderly.Meth-ods：A retrospective study of 220 cases of femoral intertrochanteric fracture were assigned to dynamic hip screw（DHS）group（82 cases）,proximal femoral nail antirotation（PFNA）group（68 cases）,hemi-hip ar-throplasty（HHA）group （70 cases）.There were 92 males and 128 females,at age range of 70 ~101 years,mean 79.8 years.According to the modification Evan classification,the fracture included typeⅠin 22,type Ⅱ in 51,type Ⅲ in 78,type Ⅳ in 44,type Ⅴ in 20,type R in 5.The Preoperative conditions, postoperative function and complications,operativing time,bleeding during the operation,postoperative full weight-bearing time,fracture healing time were comparatively studied among the three groups.Results：All cases were followed up for 8~24 months,average 13 months.All patients obtained a satisfactory effect and there were no significant differences（P＆gt;0.05 ）regarding the excellent and good rate,gender,age, fracture types and medical complications,the mean operativing time and blood loss：there were significant differences between the PFNA group,DHS group and HHA group;there were significant differences be-tween the PFNA group,DHS group（P＆lt;0.05 ）.The operativing time of PFNA group is the shortest,bleed-ing loss is the least.HHA group had the longest operativing time and the most bleeding loss.DHS group is the medium.The mean walking time and completely loading time,PFNA group A took the least time than HHA group and DHS group,there are significant differences （P＆lt;0.05 ）,union time：there are no signifi-cances between the PFNA group,the DHS group.Postoperative complications were found in 29 cases （13.2%）.Harris score was highest in the HHA group,with satisfactory significances in comparison with the other two groups.Conclusion：Three kinds of treatment are effective for th

关 键 词：股骨转子间骨折 动力髋螺钉 股骨近端防旋髓内钉 内固定 关节成形术 置换 髋 老年人 

分 类 号：R687.3[医药卫生—骨科学]