不同内固定方法治疗老年骨质疏松性股骨粗隆间骨折的临床观察

目的 观察防旋型股骨近端髓内钉(proximal femoral nail anti-rotation,PFNA)、动力髋螺钉(dynamic hip screw,DHS)、Gamma钉三种不同内固定方法治疗老年骨质疏松性股骨粗隆间骨折的临床效果.方法 2009年1月～2012年12月,选择我院住院治疗的80例老年股骨粗隆间骨折患者作为观察对象,所有患者均经X线片或骨密度检查显示有明显的骨质疏松.其中28例行PFNA内固定,设立为Ⅰ组；30例行DHS内固定,设立为Ⅱ组；22例行Gamma钉内固定,设立为Ⅲ组,观察记录并比较分析三组患者的手术时间、术中出血量、骨折愈合时间、术后髋关节功能(采用Harris评分法)、术后并发症(髋内翻、骨折不愈合、骨折延迟愈合、股骨头缺血坏死、下肢静脉血栓形成).结果 Ⅰ组手术时间最短,Ⅱ组手术时间最长,Ⅰ组术中出血量最少,明显少于Ⅱ组和Ⅲ组,差异有统计学意义(P＜0.05)；全部患者均获得一期骨性愈合,愈合时间为3～8个月,Ⅰ组骨折愈合时间最快,明显短于Ⅲ组,差异有统计学意义(P＜0.05).术后髋关节功能:Ⅰ组优良率最高,达92.9％,明显高于Ⅱ组和Ⅲ组,差异有统计学意义(P＜0.05).Ⅰ组无一例发生髋内翻、骨折不愈合、骨折延迟愈合、股骨头缺血坏死、下肢静脉血栓形成,Ⅱ组并发症发生率最高,达23.3％,明显高于Ⅰ组和Ⅲ组,差异有统计学意义(P＜0.05).Ⅲ组出现骨折不愈合1例,下肢静脉血栓形成1例.结论 不同内固定方法治疗老年骨质疏松性股骨粗隆间骨折各具优缺点,PFNA内固定更具优势.

Clinical observation of different fixation methods for the treatment of os- teoporotic intertrochanteric fractures

Objective To observe the clinical effects of the anti-spin-proximal femoral nail （proximal femoral nail anti- rotation, PFNA）, dynamic hip screw （dynamic hip screw, DHS）, Gamma nail three different fixation methods for the treatment of osteoporotic intertrochanteric fractures. Methods From January 2009 to December 2012 in our hospital 80 cases of intertroehanteric fracture patients as observation objects, selected 80 patients with osteoporotic intertrochanter- ic fractures were confirmed by X-ray piece obvious osteoporosis or bone density examination. 28 cases PFNA fixed set up for group Ⅰ , 30 cases DHS fixation, the establishment of group Ⅱ , 22 patients Gamma nail fixation, the estab- lishment of group Ⅲ, observe, record and comparative analysis of the three groups of patients, the operation time, blood loss, fracture healing time, postoperative hip function using Harris score, postoperative complications （varus nonunion, delayed union, avascular necrosis, deep vein thrombosis）. Results Operative time of groupⅠ was the short- est and the longest operation time of group Ⅱ , groupⅠ the least blood loss was significantly less than group Ⅱ and group Ⅲ, the difference was statistically significant （P 〈 0.05） ; All patients were a bone sexual healing, the healing time of 3-8 months, Ⅰ group the fastest healing time was significantly shorter in group Ⅲ, the difference was statis- tically significant （P 〈 0.05）. Postoperative hip function used Harris score the group Ⅰ postoperative fine the highest rate of 92.9%, significantly higher than group Ⅱ and group IU excellent rate, and the difference was statistically sig- nificant （P 〈 0.05）. Group Ⅰ had no case of varus nonunion, delayed union, avascular necrosis, deep vein thrombosis, the group Ⅱ complication rate was the highest （23.3%）, was significantly higher than in group Ⅰ and group Ⅲ, the difference There are statistically significant （P〈 0.05）. Group Ⅲ nonunion in 1 case, deep vein thrombosis cases. Conclusion Different fixation methods for the treatment of osteoporotic intertrochanteric fracture have the advantages and disad- vantages, and PFNA has more advantages.