髓内和髓外固定治疗老年股骨转子间骨折的疗效比较  

Comparison efficacy of intramedullary and extramedullary fixation in the treatment of intertrochanteric fractures in the elderly patients

作　　者：刘洪业[1] 付国建[1] 

机构地区：[1]马鞍山市人民医院骨科,安徽马鞍山243000

出　　处：《临床骨科杂志》2017年第6期730-732,共3页Journal of Clinical Orthopaedics

摘　　要：目的比较髓内和髓外两种内固定方法治疗老年股骨转子间骨折的临床疗效。方法将42例老年股骨转子间骨折患者按治疗方法分为髓内组(应用股骨近端防旋髓内钉固定)和髓外组(应用动力髋螺钉或股骨近端锁定钢板固定),各21例。比较两组切口长度、手术时间、术中出血量、术后引流量、住院时间、骨折愈合时间以及髋关节功能Harris评分。结果患者均获得随访,时间6~24个月。手术时间、切口长度、术中出血量、术后引流量、住院时间、骨折愈合时间髓内组均少于髓外组(P<0.05)。术后6个月髋关节功能Harris评分:髓内组优16例,良3例,可2例,优良率19/21;髓外组优13例,良4例,可3例,差1例,优良率17/21;髓内组优良率高于髓外组(P<0.05)。结论髓内固定治疗老年股骨转子间骨折较髓外固定疗效更好。Objective To compare clinical outcomes of intramedullary and extramedullary fixation in the treatment of intertrochanteric fractures in the elderly patients.Methods Forty-two elderly patients with intertrochanteric fractures were divided into intramedullary group （ fixed with proximal femoral nail antirotation fixation ） and extramedullary group （fixed with dynamic hip screw or proximal femoral locking fixation ）,with every group 21 cases.The incision length, operative time, intraoperative blood loss, postoperative drainage, hospitalization time, fracture healing time and Harris scores of hip function were compared between two groups.Results The follow-up period was 6 ~24 months.In intramedullary group, operation time, incision length, intraoperative blood loss, postoperative drainage and hospitalization time were significantly less than those in extramedullary group （ P〈0.05 ）.At 6 months follow-up, Harris scores in intramedullary group demonstrated excellent hip function in 16 cases, good in 3, fair in 2, with excellent-good rate of 19/21;while in extramedullary group , Harris scores showed excellent in 13 cases, good in 4, fair in 3, and poor in 1, with an excellent-good rate of 17/21.The excellent-good rate of intramedullary group was significantly higher than that of extramedullary group （P〈0.05）.Conclusions Compared with extramedullary fixation, intramedullary fixation can obtain better clinical outcomes in the elderly patients with intertrochanteric fractures.

关 键 词：股骨转子间骨折 股骨近端防旋髓内钉 骨折固定术 内 老年人 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]