不同内固定方式对老年股骨粗隆间骨折全身情况的影响  

Effects of general condition using different fixation methods on elderly patients with intertrochanteric fractures

作　　者：王晓伟[1] 孙天胜[1] 刘智[1] 张建政[1] 

机构地区：[1]北京军区总医院骨科,北京100700

出　　处：《中国骨与关节损伤杂志》2017年第2期133-136,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨动力髋螺钉(DHS)、股骨近端防旋髓内钉(PFNA)及Inter Tan内固定对老年股骨粗隆间骨折全身情况的影响。方法笔者自2012-01—2013-12共诊治老年股骨粗隆间骨折189例,根据内固定方式分为DHS、PFNA、Inter Tan 3组,分别比较3组术中情况(麻醉方式、手术时间、失血量)、白细胞计数、血红蛋白、氧分压(PO2)、并发症、死亡率等。结果 3组麻醉方式、手术时间比较差异均无统计学意义(P>0.05);Inter Tan组显性、隐性失血量及输血量均较DHS组和PFNA组多,差异有统计学意义(P<0.05);3组术前白细胞计数差异不明显,术后均有不同程度升高,Inter Tan组术后1、3、5 d白细胞计数水平较其他2组明显升高,术后3 d差异有统计学意义(P<0.05);3组术前血红蛋白水平差异不明显,术后均有不同程度下降,3组术后1、3 d血红蛋白水平差异均有统计学意义(P<0.05);3组术前PO2差异无统计学意义,术后均有不同程度下降,术后1、3、5 d Inter Tan组下降最明显,其次为PFNA组,DHS组最高,差异有统计学意义(P<0.05);术前谷丙转氨酶3组间差异无统计学意义(P>0.05),3组术后1、3 d差异有统计学意义(P<0.05);DHS组住院期间并发症6例,PFNA组8例,Inter Tan组14例,3组比较差异均无统计学意义(P>0.05)。结论髓内及髓外固定均可对机体产生一定影响,髓内固定中的Inter Tan对失血量、白细胞计数、血红蛋白、PO2影响最大,但3种内固定方式对于总体结局(死亡及并发症)的影响差异不大。Objective To investigate the effect of general condition using dynamic hip screw （DHS）, proximal femoral nail （PFNA） and InterTan on the body condition of the elderly patients with intertrochanteric fractures. Methods A total of 189 elderly patients with intertrochanteric fractures were treated from Jan 2012 to Dec 2013, and were divided into DHS, PFNA and InterTan groups. The 3 groups were compared for intraoperative conditions（anesthesia, operative time, blood loss, etc.）, the blood indexes （white blood cell count, hemoglobin, oxygen pressure）, complications and mortality. Results The type of anesthesia, and during of operation were similar for 3 groups. The observed, hidden blood loss and the amount of blood transfusion in InterTan group were significantly higher than other groups. The counts of WBC in three groups at admission were similar, and all went up quickly after operation. The counts of WBC in InterTan groups were higher at all four time points compared to others, and reached statistical difference at 3 day after operation. The values of hemoglobin were similar in three groups before operation, and all decreased quickly. The patients of DHS group showed higher levels of hemoglobin, and reached significant difference at 1 day and 3 day after operation. There were no differences for PaO2 in three groups at administration, and decreased after operation, and the levels of PaO2 for InterTan group were lowest compared to other groups at all time points. The levels of ALT for three groups showed no significant difference before operation, and increased quickly after operation, and InterTan group showed highest levels of ALT compared to others, and reached statistical difference at 1 day, 3 day after operation. 6, 8, and 14 patients of the three groups suffered complications, and did not reach significant difference in these groups. Conclusion Intramedullary and extramedullary fixations exert different influences on elderly hip fracture patients, and intramedullary nail has more impact on bloo

关 键 词：股骨粗隆间骨折 髓内固定 髓外固定 

分 类 号：R687.3[医药卫生—骨科学]