3种不同方式治疗老年股骨转子间骨折的病例对照试验

目的:通过比较分析3种不同方式治疗老年股骨转子间骨折的临床资料及其随访结果,为临床选择合适的治疗方法提供依据。方法:自2004年6月至2010年6月治疗老年股骨转子间骨折131例,其中动力髋螺钉(dy-namichipscrew,DHS)内固定组72例,男20例,女52例,年龄(72.5±5.5)岁;PFNA(proximalfemoralnailantirotation,PFNA)组43例,男12例,女31例,年龄(72.8±4.9)岁;人工股骨头置换组16例,男4例,女12例,年龄(76.0±5.0)岁。分别对3组患者手术创伤(手术时间、切口长度、X线透视次数、术中失血量),术后恢复(非负重行走时间、住院时间、临床愈合时间、术后12周Harris髋关节评分)及并发症等进行统计学分析。结果:所有患者获随访,时间6～36个月,平均18.2个月。手术创伤:手术切口长度、手术时间及术中失血量方面,DHS组>人工股骨头置换组>PFNA组;X线透视次数PFNA组最多,人工股骨头置换组最少。术后恢复:非负重行走时间、住院时间、临床愈合时间方面,DHS组>PFNA组>中人工股骨头置换组。术后12周Harris评分,人工股骨头置换组明显高于DHS组和PFNA组;DHS组与PFNA组相比差异无统计学意义。术后并发症发生情况:DHS组比PFNA组发生率高,3组总体比较差异无统计学意义。结论:PFNA可以作为老年性股骨转子间骨折优先考虑的疗法。DHS较为适合于基层医院、AI型骨折及骨折部位在PFNA入点附近;而人工股骨头置换术是治疗粉碎性不稳定型并(或)高龄严重骨质疏松性转子间骨折的理想方法之一,但不优先考虑。

Comparison of three methods for the treatment of aged femoral intertrochanteric fracture

Objective: To investigate the reasonable methods of treatment for aged intertrochanteric fractures through the comparison and analysis about the clinical data and follow-up results of three kinds of treatment method of elderly intertrochanteric fractures. Methods:From June 2004 to June 2010,131 patients with intertrochanteric fractures were treated and reviewed retrospectively. Among them,72 patients were treated with dynamic hip screw(DHS) included 20 males and 52 females with an average age of(72.5±5.5) years,43 patients were treated with proximal femoral nail antirotation(PFNA) included 12 males and 31 females with an average age of (72.8±4.9) years and 16 patients were treated with hemiarthroplasty included 4 males and 12 females with an average age of (76.0±5.0) years. The three groups of patients were statistically analyzed and compared on surgical trauma including operation time,blood loss,incision length,X-ray exposure,and on postoperative recovery including non-weight-bearing walking time,the hospitalization time,the healing time,the recovery of joint function and complications. Results:All patients were followed-up from 6 months to 3 years (means 18.2 months). In surgical trauma: the results of length of incision,operation time and blood loss was DHS>hemiarthroplasty>PFNA. PFNA group had the most X-ray exposure,hemiarthroplasty group had the least. In postoperative recovery: the results of in non-weight-bearing walking time,hospitalization time and healing time was DHS>PFNA>hemiarthroplasty. Harris scores at 12 weeks after operation in hemiarthroplasty was higher than that of DHS and PFNA,but there was no statistical difference between DHS and PFNA. The incidence of postoperative complications in DHS group was more than that of PFNA group,but there were not significant differences among three groups. Conclusion:PFNA is prepered in the treatment of senile intertrochanteric fractures. DHS fixation is more suitable for primary hospital and AI-type fracture and the fracture near the entry point of PFNA. The hemiarthroplasty is one of the best ways to treat unstable comminuted and/or severe osteoporosis of elderly intertrochanteric fracture. However,it isn't generally considered.