四种手术方式治疗高龄骨质疏松性股骨转子间骨折的回顾性分析  

Retrospective analysis of the four surgical patterns for the treatment of osteoporotic intertrochanter fractures in the elderly

作　　者：白志刚[1] 宋强[1] 程锁利[1] 孙玺淳[1] 马军[1] 杨绿林[1] 黄朋[1] 牛东生[1] 

机构地区：[1]宁夏回族自治区人民医院西夏院区骨二科,宁夏银川750004

出　　处：《中国骨质疏松杂志》2017年第6期790-794,共5页Chinese Journal of Osteoporosis

基　　金：宁夏回族自治区科技攻关项目

摘　　要：目的探讨治疗高龄骨质疏松性股骨转子间不稳定性骨折的方法及疗效。方法对我院2005年1月至2015年5月收治的以股骨近端防旋髓内钉(PFNA)、股骨近端解剖锁定钢板(PPF-LCP)、髋关节置换术(HRP)和动力髋螺钉(DHS)手术的194例高龄骨质疏松性股骨转子间不稳定骨折患者进行回顾性研究,分别对各组的手术时间、出血量、住院时间、术后下床活动时间、Harris评分、并发症等指标进行统计学分析,评价4种治疗方法的特点及优劣。结果 PFNA组手术及住院时间最短,关节置换组次之,PF-LCP组第三,DHS组最长;PFNA组出血量最少,而关节置换组、PF-LCP组与DHS组差异无统计学意义;关节置换组离床时间最早,PFNA组次之,PF-LCP组与DHS组差异无统计学意义,术后1月的Harris评分GTF假体组明显高于其他3组,PFNA组高于PF-LCP组与DHS组,PF-LCP组高于DHS组,而术后6月的Harris评分发现无明显差异。结论对于高龄骨质疏松性股骨转子间不稳定性骨折,治疗的关键在于降低手术风险、尽早离床活动、避免术后并发症,对于身体状况尚佳、骨质疏松程度低、骨折粉碎程度轻者首选PFNA,相反,若患者合并有严重的骨质疏松、骨折部粉碎程度重则髋关节置换术更具优势,DHS需谨慎选择。Objective To investigate the methodology and efficacy of the treatment on unstable osteoporotic intertrochanteric fractures in the elderly. Methods A total of 194 elder patients,who accepted operation of proximal femoral nail anti-rotation（PFNA）,or dynamic hip screw（DHS）,or hip replacement,or proximal femur locking compress plate（PF-LCP） for unstable intertrochanteric fractures in our hospital from January 2005 to May 2015,were retrospectively analyzed. The operation time,amount of bleeding,time of hospital stay,ambulation time,score of Harris,and complication,etc.,were evaluated. Results The surgery and hospitalization time was the shortest in PFNA group,and followed by GTF prosthetic group,PF-LCP group,and DHS group（P〈0. 01）. The amount of bleeding was the lowest in PFNA group,and it was no statistical difference among joint replacement group,PF-LCP group,and DHS group. The ambulation time was the shortest in GTF prosthetic group,and followed by PFNA group,PF-LCP group,and DHS group,with no statistical difference. Harris score was the highest in GTF prosthetic group,and followed by PFNA group,PF-LCP group,and DHS group after 1 month of operation（P〈0. 01）,and it was not significantly different among the 4 groups after 6 months of operation（P〈0. 01）. Conclusion The key of treatment for elderly patients with femoral intertrochanteric unstable fracture is how to reduce operation risk,to shorten the ambulating time,and to avoid complications. PFNA should be preferred for the patients with better physical condition,low degree of osteoporosis,and lighter degree of fracture comminution. On the contrary,hip arthroplasty has more advantage for patients with severe osteoporosis and heavy fracture comminution degree,and DHS needs to be chosen carefully.

关 键 词：股骨近端抗旋髓内钉 动力髋螺钉 锁定钢板 髋关节置换术 股骨转子间骨折 高龄 骨质疏松 

分 类 号：R683.42[医药卫生—骨科学]