老年股骨粗隆间骨折的外科治疗及其临床疗效观察  

Surgical Treatments of Geriatric Femoral Intertrochanteric Fractures and the Clinical Outcomes

作　　者：杨中锋[1] 陈洪亮[1] 郑强[1] 

机构地区：[1]沈阳市苏家屯区中心医院骨科,沈阳110101

出　　处：《医学综述》2015年第4期757-759,共3页Medical Recapitulate

摘　　要：目的探讨不同外科手术方式治疗股骨粗隆间骨折的临床疗效。方法采用病例对照研究纳入2005年7月至2011年9月沈阳市苏家屯区中心医院骨科收治的Evans-JensonⅢ型不稳定型股骨粗隆间骨折患者45例,其中行全髋置换术的患者22例(关节置换组),行防旋股骨近端髓内钉(PFNA)内固定术的患者23例(PFNA内固定组)。按Harris评分系统评估患者手术前后的疗效。结果PFNA内固定组的手术时间、术中出血量均少于关节置换组,术后负重行走时间多于关节置换组,差异均有统计学意义(均P<0.01)。术后根据Harris评分进行评价,关节置换组优良率为81.8%,PFNA内固定组为82.6%,两组比较差异无统计学意义(P>0.05)。术后随访情况:关节置换组无假体脱位、松动及关节感染;PFNA内固定组有效随访期内无髋内翻、螺钉切割及退钉等并发症发生,骨折均达到骨性愈合。结论 PFNA治疗不稳定性股骨粗隆间骨折,尤其是粉碎骨折、骨质疏松者,较人工关节置换具有创伤小、操作简单、出血少、固定牢固及骨量丢失少等优点。Objective To investigate the clinical effect of different surgical treatment methods for femoral intertrochanteric fractures. Methods The clinical data of 45 senile patients with Evans-Jenson Ⅲ type femoral intertrochanteric fractures from Department of Orthopedics,Central Hospital of Shenyang Sujiatun District from Jul. 2005 to Sep. 2011 were included in the case-control study. The surgical treatment methods included 22 cases of total hip arthroplasty（ THA） and 23 cases of internal fixation with proximal femoral nail anti-rotation（ PFNA）. Preoperative and postoperative hip function was evaluated by Harris criterion. Results Both of the operative time and the volume of blood loss of the PFNA internal fixation group were less than the THA group,while the weight-bearing walk time after surgery of the PFNA group was longer than the THA group,there was statistically significant difference（ P〈0. 01）. According to the Harris criterion,the excellent and good rate of the THA group was 81. 8%,of the PFNA group was 82. 6%,there was no statistically significant difference（ P〈0. 05）. No complications such as joint dislocation,prosthesis loosening,infection in the THA group,no coxa vara,cut-out and screw extraction occurred in PFNA group. The fracture all reached bone union healing. Conclusion PFNA,comparing to THA,has the advantages of small invasion,easy-to-perform,less blood loss,less bone loss and stable fixation in treatment of unstable comminuted intertrochanteric fracture,especially in old patients with osteoporosis.

关 键 词：股骨粗隆间骨折 防旋股骨近端髓内钉 骨折内固定术 人工关节置换 老年患者 

分 类 号：R683.42[医药卫生—骨科学]