钉板固定、髓内固定及人工股骨头置换修复高龄股骨转子间骨折:选择与比较  

Screw plate fixation, intramedullary fixation and artificial femoral head replacement in the repair of femoral intertrochanteric fractures in the elderly: choice and comparison

作　　者：左进步[1] 余磊[1] 梁宏伟[1] 王伟[1] 赵斌[1] 

机构地区：[1]武警北京总队医院骨科,北京市100027

出　　处：《中国组织工程研究》2015年第17期2711-2718,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前临床用于修复股骨转子间骨折的内固定材料总体来说分为髓内系统和髓外系统两种,而对于不稳定的股骨转子间骨折采用人工关节置换,不同修复方式的治疗效果尚缺乏宏观的比较。目的:探讨及对比不同修复方式对高龄股骨转子间骨折的修复效果。方法:纳入2005年6月至2010年6月武警北京总队医院骨科收治的高龄股骨转子间骨折患者168例,分别采用钉板固定系统(动力髋螺钉、动力髁螺钉)、髓内固定系统(Gamma3钉、膨胀髓内钉)及人工股骨头置换进行修复,其中男69例,女99例;年龄75-94岁,平均81.4岁;根据Evans分型,Ⅰ型20例,Ⅱ型43例,Ⅲ型57例,Ⅳ型33例,Ⅴ型15例。对各组患者的手术时间、出血量、下地负重时间、髋关节功能进行对比评价。结果与结论:患者治疗后随访14-39个月。治疗后12个月采用Harris评分对患侧髋关节进行功能评定,骨折均在12个月内愈合,4组修复结果优良率及比较差异无显著型意义(P>0.05)。膨胀髓内钉组在手术时间、出血量方面均显著优于其他各组(P<0.05)。人工股骨头组在下地负重时间方面显著优于其他各组(P<0.01)。提示根据骨折分型,结合老年患者骨质疏松情况选择适当的修复方式可以提高股骨转子间骨折的疗效,减少治疗后并发症。EvansⅠ、Ⅱ型稳定性股骨转子间骨折首选动力髋螺钉内固定,Ⅲ-Ⅴ型不稳定性骨折可选择髓内固定系统,不稳定性骨折合并明显骨质疏松的高龄患者宜选择人工关节置换。BACKGROUND： Nowadays, the internal fixation materials for the clinical treatment of femoral intertrochanteric fractures are broadly divided into two categories： intramedullary fixation system and extramedullary fixation system. Artificial femoral head replacement can be selected for unstable intertrochanteric fractures. However, the effects of diverse treatments usually lack of macroscopical evaluation. OBJECTIVE： To investigate and compare the clinical effects of different surgical treatments for femoral intertrochanteric fractures in the elderly. METHODS： 168 elderly patients with intertrochanteric fractures, who were treated in the Department of Orthopedics, Beijing Municipal Corps Hospital of Chinese People＇s Armed Police Forces from June 2005 to June 2010, were enrolled in this study. They were treated by screw plate fixation system （dynamic hip screw, dynamic condylar screw）, intramedullary fixation system （Gamma 3 nail, expandable intramedullary nail） and artificial femoral head replacement, including 69 males and 99 females, at the age of 75-94 years, averagely 81.4 years. According to Evans type, there were 20 cases of type I, 43 cases of type Ⅱ, 57 cases of type III, 33 cases of type IV and 15 cases of type V. Operative time, blood loss, weight-bearing ambulation time, and hip function were compared and evaluated in patients of each group. RESULTS AND CONCLUSION： After treatment, patients were followed up for 14-39 months： At 12 months after treatment, Harris score was used to assess hip function in the affected side. Fracture was healed within 12 months. There was no significant difference in excellent and good rate among four groups （P 〉 0.05）. Operative time and blood loss were significantly better in the expandable intramedullary nail group than in the other groups （P 〈 0.05）. Weight-bearing ambulation time was significantly better in the artificial femoral head group than in the other groups . （P 〈 0.01）. Results suggest that according to fracture typing, i

关 键 词：股骨 骨折 股骨头 髋假体 内固定器 植入物 骨植入物 高龄 股骨转子间骨折 人工股骨头置换 内固定 预后 

分 类 号：R318[医药卫生—生物医学工程]