创伤与急危重病医学
創傷與急危重病醫學
창상여급위중병의학
Trauma and Critical Care Medicine
2014年
2期
92-96,107
,共6页
张磊%吴震东%黄宰宇%何帅%应志豪%刘丹
張磊%吳震東%黃宰宇%何帥%應誌豪%劉丹
장뢰%오진동%황재우%하수%응지호%류단
股骨粗隆间骨折%不稳定性%老年骨质疏松%锁定型Gamma钉%动力髋螺钉
股骨粗隆間骨摺%不穩定性%老年骨質疏鬆%鎖定型Gamma釘%動力髖螺釘
고골조륭간골절%불은정성%노년골질소송%쇄정형Gamma정%동력관라정
intertrochanteric hip fractures%unstable%geriatric osteoporosis%locking Gamma nail%dynamic hip screw
目的:探讨锁定型Gamma钉(locking Gamma nail,LGN)与动力髋螺钉(dynamic hip screw,DHS)治疗老年骨质疏松性股骨粗隆间骨折的临床疗效,并进行对比分析。方法对2008年1月-2012年3月在我院采用LGN和DHS内固定治疗且获得随访的年龄≥60岁的不稳定性股骨粗隆间骨折患者的病历资料进行回顾性分析。LGN组67例,其中男27例,女40例,年龄60~92岁,平均年龄80.5岁;按国际内固定学会(AO)分型,A2型50例,A3型17例。DHS组70例,其中男28例,女42例,年龄61~90岁,平均年龄80.2岁;按AO分型,A2型53例, A3型17例。对手术时间、术中出血量、术后输血量、术后血红蛋白下降值、住院时间、骨折愈合时间、Harris髋关节功能评分、骨折端压缩、颈干角角度变化等情况进行对比分析。结果 LGN 组和DHS 组患者在年龄[(80.48±7.33)vs(80.21±6.93)]、性别、骨折分型、术前美国麻醉医师学会(American society of anesthesiologist,ASA)评分、术后输血量[(0.99±1.30)U vs(1.11±1.22)U]、术后血红蛋白下降值[(19.78±8.61)g/L vs(19.76±7.10)g/L]等方面比较,差异无统计学意义(P>0.05);在手术时间[(52.69±14.81)min vs(79.21±15.17)min]、术中出血量[(86.71±38.86)mL vs(256.00±62.24)mL]、住院时间[(8.52±2.53)d vs(13.04±2.54)d]等方面比较,差异有统计学意义(P<0.05)。术后随访12~36个月,骨折愈合时间[(16.75±7.41)周 vs(14.43±6.82)周]两组比较,差异无统计学意义(P>0.05);两组在骨折端压缩[(4.37±2.50)mm vs(7.97±2.86)mm]、颈干角角度变化、Harris髋关节功能评分[(86.63±6.28)vs(83.06±6.70)]等方面比较,差异有统计学意义(P<0.05)。LGN组骨折端压缩程度及颈干角度数变化较小,功能恢复较好。结论老年不稳定性股骨粗隆间骨折患者使用LGN固定有助于降低术后骨折压缩塌陷及髋内翻的发生率,功能恢复优于DHS。
目的:探討鎖定型Gamma釘(locking Gamma nail,LGN)與動力髖螺釘(dynamic hip screw,DHS)治療老年骨質疏鬆性股骨粗隆間骨摺的臨床療效,併進行對比分析。方法對2008年1月-2012年3月在我院採用LGN和DHS內固定治療且穫得隨訪的年齡≥60歲的不穩定性股骨粗隆間骨摺患者的病歷資料進行迴顧性分析。LGN組67例,其中男27例,女40例,年齡60~92歲,平均年齡80.5歲;按國際內固定學會(AO)分型,A2型50例,A3型17例。DHS組70例,其中男28例,女42例,年齡61~90歲,平均年齡80.2歲;按AO分型,A2型53例, A3型17例。對手術時間、術中齣血量、術後輸血量、術後血紅蛋白下降值、住院時間、骨摺愈閤時間、Harris髖關節功能評分、骨摺耑壓縮、頸榦角角度變化等情況進行對比分析。結果 LGN 組和DHS 組患者在年齡[(80.48±7.33)vs(80.21±6.93)]、性彆、骨摺分型、術前美國痳醉醫師學會(American society of anesthesiologist,ASA)評分、術後輸血量[(0.99±1.30)U vs(1.11±1.22)U]、術後血紅蛋白下降值[(19.78±8.61)g/L vs(19.76±7.10)g/L]等方麵比較,差異無統計學意義(P>0.05);在手術時間[(52.69±14.81)min vs(79.21±15.17)min]、術中齣血量[(86.71±38.86)mL vs(256.00±62.24)mL]、住院時間[(8.52±2.53)d vs(13.04±2.54)d]等方麵比較,差異有統計學意義(P<0.05)。術後隨訪12~36箇月,骨摺愈閤時間[(16.75±7.41)週 vs(14.43±6.82)週]兩組比較,差異無統計學意義(P>0.05);兩組在骨摺耑壓縮[(4.37±2.50)mm vs(7.97±2.86)mm]、頸榦角角度變化、Harris髖關節功能評分[(86.63±6.28)vs(83.06±6.70)]等方麵比較,差異有統計學意義(P<0.05)。LGN組骨摺耑壓縮程度及頸榦角度數變化較小,功能恢複較好。結論老年不穩定性股骨粗隆間骨摺患者使用LGN固定有助于降低術後骨摺壓縮塌陷及髖內翻的髮生率,功能恢複優于DHS。
목적:탐토쇄정형Gamma정(locking Gamma nail,LGN)여동력관라정(dynamic hip screw,DHS)치료노년골질소송성고골조륭간골절적림상료효,병진행대비분석。방법대2008년1월-2012년3월재아원채용LGN화DHS내고정치료차획득수방적년령≥60세적불은정성고골조륭간골절환자적병력자료진행회고성분석。LGN조67례,기중남27례,녀40례,년령60~92세,평균년령80.5세;안국제내고정학회(AO)분형,A2형50례,A3형17례。DHS조70례,기중남28례,녀42례,년령61~90세,평균년령80.2세;안AO분형,A2형53례, A3형17례。대수술시간、술중출혈량、술후수혈량、술후혈홍단백하강치、주원시간、골절유합시간、Harris관관절공능평분、골절단압축、경간각각도변화등정황진행대비분석。결과 LGN 조화DHS 조환자재년령[(80.48±7.33)vs(80.21±6.93)]、성별、골절분형、술전미국마취의사학회(American society of anesthesiologist,ASA)평분、술후수혈량[(0.99±1.30)U vs(1.11±1.22)U]、술후혈홍단백하강치[(19.78±8.61)g/L vs(19.76±7.10)g/L]등방면비교,차이무통계학의의(P>0.05);재수술시간[(52.69±14.81)min vs(79.21±15.17)min]、술중출혈량[(86.71±38.86)mL vs(256.00±62.24)mL]、주원시간[(8.52±2.53)d vs(13.04±2.54)d]등방면비교,차이유통계학의의(P<0.05)。술후수방12~36개월,골절유합시간[(16.75±7.41)주 vs(14.43±6.82)주]량조비교,차이무통계학의의(P>0.05);량조재골절단압축[(4.37±2.50)mm vs(7.97±2.86)mm]、경간각각도변화、Harris관관절공능평분[(86.63±6.28)vs(83.06±6.70)]등방면비교,차이유통계학의의(P<0.05)。LGN조골절단압축정도급경간각도수변화교소,공능회복교호。결론노년불은정성고골조륭간골절환자사용LGN고정유조우강저술후골절압축탑함급관내번적발생솔,공능회복우우DHS。
Objective To discuss and compare the clinical effects of locking Gamma nail (LGN)with dynamic hip screw (DHS)in the treatment of intertrochanteric femoral fractures in elder patients.Methods From January 2008 to March 2012,a retrospective study on more than 12 months follow-up of 137 elder patients(≥60 years old)with unstable intertro-chanteric femoral fractures underwent LGN or DHS were carried out.67 patients were treated with LGN,including 27 males and 40 females with an average age of 80.5 years (ranging from 60 to 92 years),50 cases of type A2 and 17 cases of type A3.70 patients were treated with DHS,including 28 males and 42 females with an average age of 80.2 years (ranging from 61 to 90 years),53 cases of type A2 and 17 cases of type A3.The operation time,blood loss,hemoglobin decrease value, blood transfusion,duration of hospitalization,fracture healing time,fracture compression,changes in neck-shaft angle and Harris score of the hip joint were observed.Results There were no significant differences between LGN group and DHS group for the age[(80.48 ±7.33)vs(80.21 ±6.93)],gender,fracture type,ASA score,blood transfusion[(0.99 ± 1.30)U vs(1.11 ±1.22)U],and hemoglobin decrease value[(19.78 ±8.61)g/L vs(19.76 ±7.10)g/L](P>0.05). There were statistically significant difference in the average operating time[(52.69 ±14.81)min vs(79.21 ±15.17)min], the average volume of intraoperative bleeding[(86.71 ±38.86)mL vs(256.00 ±62.24)mL],and duration of hospitaliza-tion[(8.52 ±2.53)d vs(13.04 ±2.54)d](P<0.05).All patients were followed up 12 to 36 months.No statistically sig-nificant difference was found in fracture healing time between the two group[(16.75 ±7.41)weeks vs(14.43 ±6.82) weeks](P>0.05).There were statistically significant difference in fracture compression[(4.37 ±2.50)mm vs(7.97 ± 2.86)mm],changes in neck-shaft angle and Harris score of the hip joint[(86.63 ±6.28)vs(83.06 ±6.70)](P<0.05 ).LGN group was superior to DHS group in fracture compression,Harris hip score and changes in neck-shaft angle (P<0.05).Conclusion Treatment of geriatric unstable intertrochanteric hip fractures with LGN contributes to decrease fracture compression and coxa vara,which can attain a more satisfactory clinical efficacy compared to the DHS.