重建股骨距与股骨近端防旋髓内钉治疗老年不稳定股骨粗隆间骨折的疗效比较  

Comparison of clinical effect betweem reconstructing femoral calcar and proximal femoral antirotation nail for the treatment of unstable femoral intertrochanteric fracture in elderly patients

作　　者：孙群周[1] 阮成群[1] 李光明[1] 陈武林[1] 丁强[1] 张春健[1] 

机构地区：[1]河南省洛阳正骨医院,河南洛阳471002

出　　处：《中国骨伤》2016年第8期684-688,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：比较两种不同内固定方式治疗老年不稳定股骨粗隆间骨折的临床疗效。方法 ：对2009年8月至2014年8月筛选的股骨粗隆间骨折患者68例进行回顾性分析,分别采用股骨近端外侧锁钉钢板辅助前侧短重建钢板（重建股骨距组）,股骨近端防旋髓内钉（PFNA组）两种手术方式治疗。重建股骨距组：男8例,女22例;年龄63~85岁,平均（73.41±5.12）岁;病程1~3 d;骨折按AO/ASIF分型,AO 31-A2.2型12例,A2.3型11例,A3.3型7例。PF NA组：男10例,女28例;年龄65~90岁,平均（74.26±4.53）岁;病程1~3 d;AO 31-A2.2型15例,A2.3型13例,A3.3型10例。68例患者均为外伤致患侧髋部疼痛、肿胀,X线片证实股骨粗隆间骨折。分析比较两组切口长度、手术时间、出血量、手术质量、骨折愈合时间、开始部分负重时间、术后并发症以及髋关节功能评分（Harris评分）。结果：术后切口均Ⅰ期愈合。并发症：PFNA组出现螺旋刀片切割1例,深静脉血栓1例;重建股骨距组深静脉血栓1例,两组比较,差异无统计学意义（χ2=0.000,P=1.000）。68例患者均获随访,时间20~24个月,平均22.5个月。两组患者部分负重时间、术后并发症、Harris评分比较差异无统计学意义;两组手术切口长度、手术时间、术中失血量、骨折愈合时间差异有统计学意义。手术切口长度、手术时间、术中失血量：PFNA组明显低于重建股骨距组（P〈0.001）。愈合时间：PFNA组低于重建股骨距组（P〈0.05）。结论：重建股骨距和PFNA治疗老年不稳定股骨粗隆间骨折均有良好疗效,PFNA内固定操作简单、创伤小、愈合快,应为首选。Objective：To compare the clinical effects of two methods of internal fixation in treating unstable femoral intertrochanteric fractures in elderly patients. Methods：From August 2009 to August 2014,68 elderly patients with unstable femoral intertrochanteric fracture treated with locking proximal femur plate and auxiliary short reconstructed plate（reconstructing calcar group） and proximal femoral nail antirotation（PFNA group） with clinical course from 1 to 3 days were retrospectively analyzed. In reconstructing calcar group,there were 30 patients including 8 males and 22 females,aged from 63 to85 years old with an average of（73.41±5.12） years old,the fractures were classified to type AO 31-A2.2 in 12 cases,A2.3 in11 cases,A3.3 in 7 cases according to AO / ASIF classification. In PFNA group,there were 38 patients including 10 males and28 females,aged from 65 to 90 years old with an average of（74.26±4.53） years old,the fractures were classified to type AO31-A2.2 in 15 cases,A2.3 in 13 cases,A3.3 in 10 cases. All fracture were caused by injury,leading pain and swelling.Femoral intertrochanteric fracture was confirmed by X ray films. The data of each group were collected for statistical analysis on the following aspects：the incision length,operation time,blood loss volume,postoperative partial weight bearing standing time,clinical healing time of fracture,postoperative complications,and hip functional score of Harris. Results：All incisions were healed at stage Ⅰ. In the aspect of postoperative complications,there were 1 case of screw blade cutting and 1 case of deep venous thrombosis in PFNA group;there was 1 case of deep venous thrombosis in the reconstructing calcar group（χ2=0.000,P=1.000）. Patients were followed up from 20 to 24 months with an average of 22.5 months. There were no significant in postoperative partial weight bearing standing time,postoperative complications,hip functional score of Harris between two group. There were significant in the incision length,operation time,bl

关 键 词：股骨骨折 骨折固定术 内 老年人 病例对照研究 

分 类 号：R683.42[医药卫生—骨科学]