老年股骨转子间骨折不同手术方法比较研究  

The Efficacy Analysis of Different Surgical Methods in Treatment of Senile Intertrochanteric Fractures

作　　者：沈宁江[1] 林坚平[1] 王广积[1] 黎早敏[1] 陈剑飞[1] 林庆彪[1] 

机构地区：[1]海南省人民医院骨科中心,海南海口570311

出　　处：《实用骨科杂志》2016年第1期6-10,共5页Journal of Practical Orthopaedics

摘　　要：目的比较动力髋螺钉(dynamic hip screw,DHS)、解剖型锁定钛板(locking compression plate,LCP)、防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)、人工股骨头置换治疗老年股骨转子间骨折的疗效。方法527例老年股骨转子间骨折中DHS治疗182例,LCP治疗201例,PFNA治疗71例,人工股骨头置换73例。结果DHS、LCP、PFNA、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);PFNA组术中出血量明显少于DHS、LCP、人工股骨头置换组,差异有统计学意义(P<0.05),但卧床时间DHS、LCP组明显长于PFNA、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评分标准评定优良率DHS组明显低于LCP、PFNA、人工股骨头置换组,差异均有统计学意义(P<0.05)。结论 PFNA是治疗老年股骨转子间骨折理想的内固定方式,人工股骨头置换适用于75岁以上高龄不稳定型转子间骨折并且合并重度骨质疏松的患者。Objective To compare the efficacy of dynamic hip screw（ DHS）,anatomical locking compression plate（ LCP）,proximal femoral nail antirotation（ PFNA） and hemiarthroplasty in the treatment of senile intertrochanteric fractures.Methods 527 elderly patients with intertrochanteric fracture had undergone surgery,with 182 cases of DHS,201 cases of LCP,71 cases of PFNA and 73 cases of hemiarthroplasty respectively. Results The averaged operative time were similar in four groups,and the difference was not statistically significant（ P〉0.05）. Blood loss was significantly less in PFNA group than the other three groups,the difference was statistically significant（ P〈0.05）. Bed rest time in DHS group and LCP group were significantly longer than that in PFNA and hemiarthroplasty group,with statistically difference（ 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 other three groups,the difference was statistically significant（ P〈0.05）. Conclusion PFNA is an ideal internal fixation method in treating senile intertrochanteric fractures. Hemiarthroplasty applicable to patients elder than 75 years with unstable intertrochanteric fracture type and severe osteoporosis.

关 键 词：股骨转子间骨折 动力髋螺钉 解剖型锁定钛板 防旋型股骨近端髓内钉 双极人工股骨头置换 

分 类 号：R683.42[医药卫生—骨科学]