高龄转子间骨折4种手术方式167例疗效分析

目的探讨高龄患者股骨转子间骨折手术方式的选择和疗效。方法回顾性分析2003年6月至2009年1月本科获得随访的167例老年人股骨转子间骨折手术治疗方式疗效。手术方式分为4组,A组:DHS;B组:股骨近端解剖型锁定加压钢板;C组:髓内内固定(包括PFN、Gamma钉);D组:人工髋关节置换(包括人工股骨头置换、全髋关节置换)。随访12~60个月,平均30个月。根据手术时间、术中出血量、术后引流量、卧床时间等围手术期手术参数,评定比较围手术期风险;依据Harris评分评价髋关节功能;比较术后并发症发生率。结果 D组围手术期手术参数最低(P<0.01),B组、C组两组相当(P>0.05),A组最高(P<0.01);髋关节功能评分,术后1、3、6个月D组优于其他组(P<0.01),A、B、C 3组相当(P>0.05),术后12个月各组差异无统计学意义(P>0.05);术后并发症发生率A组最高,其余各组相当,但差异无统计学意义(P>0.05)。结论对于骨质疏松的高龄转子间骨折,髋关节置换治疗股骨转子间骨折较为满意,髓内固定和股骨近端解剖型锁定加压钢板也是合适的选择,DHS应谨慎选用。

The therapeutic effect analysis of the four different modus operandi for the intertrochanteric hip fractures in 167 senile patients

Objective To approach the method and the choice and therapeutic effect of this four different modus operandi for the intertrochanteric hip fractures in senile patients.Methods The retrospective analysis was used by the 167 senile patiens,who got 12 to 60 month follow-up visit,from June 2003 to January 2009,saffeved from the intertrochanteric hip fractures,the Evans′ fracture typing being used,incluing type Ⅰ 12 instance,type Ⅱ 86,type Ⅲ 56,type Ⅳ13.And 68 cases were male and 99 were female,aged from 65 to 91,average just 76.8.There were four groups divided according to operation method.Group A used DHS,and group B dynamic locking blade plate,who used PFN or Gamma nail be sum up to group C,and grop D were treated by hip replacement.Risk encircles surgery time were evaluated by operation time,blood volume during operation,drain fluence and bed-time,and hip-join function were estimated by Harris score.The postoperative complication rate was calculated.Results The contrast of operation time and blood volume during operation in this research had no difference,just group A was the maximum as group D was the minimum(P<0.01),group B had no difference with group C(P>0.05),which was in the medium.And the statistics of drain fluence and bed-time had the same result,that the anterior three groups had no disparation(P>0.05),but group D got the minimum(P<0.01),showing that hip replacement was the advanced method.Conclusion For intertrochanteric fracture with osteoporotic in senile patient,hip replacement is a satisfactory surgery modus,intramedullary fixation as well as dynamic locking blade plate just like be suitable,but DHS will be got sparing adoption cautiously.