中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
2期
108-112
,共5页
陶正刚%韦盛旺%赵友明%杨杰%杨翔%陈林%陈华%郭晓山
陶正剛%韋盛旺%趙友明%楊傑%楊翔%陳林%陳華%郭曉山
도정강%위성왕%조우명%양걸%양상%진림%진화%곽효산
髋骨折%骨折固定术,内%骨板%骨钉%回顾性研究
髖骨摺%骨摺固定術,內%骨闆%骨釘%迴顧性研究
관골절%골절고정술,내%골판%골정%회고성연구
Hip fractures%Fracture fixation,internal%Bone plates%Bone nails%Retrospective studies
目的 比较动力髋螺钉(DHS)、股骨近端防旋髓内钉(PFNA)及倒置股骨远端微创内固定系统(LISS-DF)治疗股骨转子间不稳定型骨折的临床疗效.方法 对2008年1月至2010年10月收治且获得随访的42例股骨转子间不稳定型骨折患者资料进行回顾性分析,男23例,女19例；平均年龄为66.3岁(19 ～96岁).根据内固定方式不同分为3组:DHS组20例,PFNA组16例,倒置LISS-DF组6例.3组患者术前一般资料比较差异均无统计学意义(P＞0 05),具有可比性.比较3维患者的手术时间、术中出血量、骨折复位质量、住院时间、术后负重时间、骨折愈合时间、术后并发症发生情况及术后6个月髋关节Harris评分等. 结果 42例患者术后获6～30个月(平均18.5个月)随访.DHS组、PFNA组、倒置LISS-DF组术中出血量平均分别为(364.5±262.2)、(176.3±86.3)、(205.0±77.1)mL,术后负重时间平均分别为(25.9±6.3)、(16.7±3.5)、(23.8±4.0)d,以上项目3组间两两比较差异均有统计学意义(P＜0.05).3组患者在手术时间、骨折复位质量、住院时间、骨折禽合时间、术后6个月髋关节Harris评分及术后并发症等方面比较差异均无统计学意义(P＞0.05).结论 PFNA是股骨转子间不稳定型骨折较适合的内固定物,当应用PFNA出现困难时,可考虑选择DHS及倒置LISS-DF进行内固定.
目的 比較動力髖螺釘(DHS)、股骨近耑防鏇髓內釘(PFNA)及倒置股骨遠耑微創內固定繫統(LISS-DF)治療股骨轉子間不穩定型骨摺的臨床療效.方法 對2008年1月至2010年10月收治且穫得隨訪的42例股骨轉子間不穩定型骨摺患者資料進行迴顧性分析,男23例,女19例；平均年齡為66.3歲(19 ～96歲).根據內固定方式不同分為3組:DHS組20例,PFNA組16例,倒置LISS-DF組6例.3組患者術前一般資料比較差異均無統計學意義(P＞0 05),具有可比性.比較3維患者的手術時間、術中齣血量、骨摺複位質量、住院時間、術後負重時間、骨摺愈閤時間、術後併髮癥髮生情況及術後6箇月髖關節Harris評分等. 結果 42例患者術後穫6～30箇月(平均18.5箇月)隨訪.DHS組、PFNA組、倒置LISS-DF組術中齣血量平均分彆為(364.5±262.2)、(176.3±86.3)、(205.0±77.1)mL,術後負重時間平均分彆為(25.9±6.3)、(16.7±3.5)、(23.8±4.0)d,以上項目3組間兩兩比較差異均有統計學意義(P＜0.05).3組患者在手術時間、骨摺複位質量、住院時間、骨摺禽閤時間、術後6箇月髖關節Harris評分及術後併髮癥等方麵比較差異均無統計學意義(P＞0.05).結論 PFNA是股骨轉子間不穩定型骨摺較適閤的內固定物,噹應用PFNA齣現睏難時,可攷慮選擇DHS及倒置LISS-DF進行內固定.
목적 비교동력관라정(DHS)、고골근단방선수내정(PFNA)급도치고골원단미창내고정계통(LISS-DF)치료고골전자간불은정형골절적림상료효.방법 대2008년1월지2010년10월수치차획득수방적42례고골전자간불은정형골절환자자료진행회고성분석,남23례,녀19례；평균년령위66.3세(19 ～96세).근거내고정방식불동분위3조:DHS조20례,PFNA조16례,도치LISS-DF조6례.3조환자술전일반자료비교차이균무통계학의의(P＞0 05),구유가비성.비교3유환자적수술시간、술중출혈량、골절복위질량、주원시간、술후부중시간、골절유합시간、술후병발증발생정황급술후6개월관관절Harris평분등. 결과 42례환자술후획6～30개월(평균18.5개월)수방.DHS조、PFNA조、도치LISS-DF조술중출혈량평균분별위(364.5±262.2)、(176.3±86.3)、(205.0±77.1)mL,술후부중시간평균분별위(25.9±6.3)、(16.7±3.5)、(23.8±4.0)d,이상항목3조간량량비교차이균유통계학의의(P＜0.05).3조환자재수술시간、골절복위질량、주원시간、골절금합시간、술후6개월관관절Harris평분급술후병발증등방면비교차이균무통계학의의(P＞0.05).결론 PFNA시고골전자간불은정형골절교괄합적내고정물,당응용PFNA출현곤난시,가고필선택DHS급도치LISS-DF진행내고정.
Objective To compare the effectiveness of the dynamic hip screw (DHS),the proximal femoral nail anti-rotation (PFNA) and the reversed LISS-DF in treatment of unstable intertrochantetic fractures.Methods From January 2008 to October 2010,42 patients with femoral peritrochanteric fractures were treated respectively with reversed LISS-DF (6 patients),DHS (20 patients) and PFNA (16 patients).There were 23 men and 19 women,aged from 19 to 96 years (average,66.3 years).There was no significant difference between groups in the general data of the patients( P ＞ 0.05).A retrospective study was performed to compare the outcomes of the 3 methods regarding operation time,perioperative blood loss,hospital stay:reduction,time for weight bearing,bone union,Harris score and complications. Results The patients were followed up for 6 to 30 months (average,18.5 months).The perioperative blood loss in 3 groups were respectively 364.5 ± 262.2 mL,176.3 ± 86.3 mL and 205.0 ± 77.1 mL,with significant between-group differences( P ＜ 0.05).The time for full weight bearing in 3 groups were 25.9 ± 6.3 days,16.7 ± 3.5 days and 23.8 ± 4.0 days,with significant between-group differences ( P ＜ 0.05).There were no significant between-group differences in operation time,hospital stay,quality of fracture reduction,time of bone union,postoperative complications or Harris score at 6 months postoperation ( P ＞ 0.05). Conclusion PFNA may be the first choice for treatment of unstable intertrochanteric fractures,with DHS and reversed LISS-DF as alternatives when PFNA management is difficult.
