中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2013年
3期
185-188
,共4页
胡阿威%喻爱喜%夏成焱%吴刚
鬍阿威%喻愛喜%夏成焱%吳剛
호아위%유애희%하성염%오강
股骨骨折,转子间%骨折固定术,内%内固定器%对比研究
股骨骨摺,轉子間%骨摺固定術,內%內固定器%對比研究
고골골절,전자간%골절고정술,내%내고정기%대비연구
Femoral fractures,intertrochanteric%Fracture fixation,internal%Internal fixators%Comparative study
目的 比较动力髋螺钉(DHS)、股骨近端解剖型锁定钢板(LPFP)、Gamma钉、股骨近端抗旋髓内钉(PFNA)治疗老年股骨转子间骨折的疗效.方法 回顾分析2006年6月至2011年9月收治的164例老年股骨转子间骨折患者的临床资料.164例分别采用DHS(42例)、LPFP(40例)、Gamma钉(36例)、PFNA(46例)内固定治疗,对4组的手术时间、术中出血量、骨折临床愈合时间、术后并发症及术后6个月Harris髋关节功能评分进行比较.结果 术后随访6~ 36个月.DHS、LPFP、Gamma钉、PFNA组的手术时间分别为(103±15)、(90±13)、(79±11)和(65±9)min,术中出血量分别为(202±23)、(181 ±23)、(98±13)和(87±11)ml,骨折临床愈合时间分别为(16.1±1.9)、(14.6±1.8)、(12.9±1.7)和(11.5±1.4)周,差异均有统计学意义(F值分别为2.87、3.21、2.66,均P<0.05);术后发生并发症比例分别为4/42、3/40、2/36和1/46,术后6个月Harris髋关节功能评分优良率分别为81% (34/42)、85% (34/40)、89% (32/36)和93% (43/46),差异均有统计学意义(x2=5.67,H=20.03,均P<0.05).结论 治疗老年股骨转子间骨折应根据患者全身情况及骨折分型选择不同的内固定方法,髓内固定(Gamma钉、PFNA)优于髓外固定(DHS、LPFP);PFNA疗效优于其他3组,是优先的治疗选择.
目的 比較動力髖螺釘(DHS)、股骨近耑解剖型鎖定鋼闆(LPFP)、Gamma釘、股骨近耑抗鏇髓內釘(PFNA)治療老年股骨轉子間骨摺的療效.方法 迴顧分析2006年6月至2011年9月收治的164例老年股骨轉子間骨摺患者的臨床資料.164例分彆採用DHS(42例)、LPFP(40例)、Gamma釘(36例)、PFNA(46例)內固定治療,對4組的手術時間、術中齣血量、骨摺臨床愈閤時間、術後併髮癥及術後6箇月Harris髖關節功能評分進行比較.結果 術後隨訪6~ 36箇月.DHS、LPFP、Gamma釘、PFNA組的手術時間分彆為(103±15)、(90±13)、(79±11)和(65±9)min,術中齣血量分彆為(202±23)、(181 ±23)、(98±13)和(87±11)ml,骨摺臨床愈閤時間分彆為(16.1±1.9)、(14.6±1.8)、(12.9±1.7)和(11.5±1.4)週,差異均有統計學意義(F值分彆為2.87、3.21、2.66,均P<0.05);術後髮生併髮癥比例分彆為4/42、3/40、2/36和1/46,術後6箇月Harris髖關節功能評分優良率分彆為81% (34/42)、85% (34/40)、89% (32/36)和93% (43/46),差異均有統計學意義(x2=5.67,H=20.03,均P<0.05).結論 治療老年股骨轉子間骨摺應根據患者全身情況及骨摺分型選擇不同的內固定方法,髓內固定(Gamma釘、PFNA)優于髓外固定(DHS、LPFP);PFNA療效優于其他3組,是優先的治療選擇.
목적 비교동력관라정(DHS)、고골근단해부형쇄정강판(LPFP)、Gamma정、고골근단항선수내정(PFNA)치료노년고골전자간골절적료효.방법 회고분석2006년6월지2011년9월수치적164례노년고골전자간골절환자적림상자료.164례분별채용DHS(42례)、LPFP(40례)、Gamma정(36례)、PFNA(46례)내고정치료,대4조적수술시간、술중출혈량、골절림상유합시간、술후병발증급술후6개월Harris관관절공능평분진행비교.결과 술후수방6~ 36개월.DHS、LPFP、Gamma정、PFNA조적수술시간분별위(103±15)、(90±13)、(79±11)화(65±9)min,술중출혈량분별위(202±23)、(181 ±23)、(98±13)화(87±11)ml,골절림상유합시간분별위(16.1±1.9)、(14.6±1.8)、(12.9±1.7)화(11.5±1.4)주,차이균유통계학의의(F치분별위2.87、3.21、2.66,균P<0.05);술후발생병발증비례분별위4/42、3/40、2/36화1/46,술후6개월Harris관관절공능평분우량솔분별위81% (34/42)、85% (34/40)、89% (32/36)화93% (43/46),차이균유통계학의의(x2=5.67,H=20.03,균P<0.05).결론 치료노년고골전자간골절응근거환자전신정황급골절분형선택불동적내고정방법,수내고정(Gamma정、PFNA)우우수외고정(DHS、LPFP);PFNA료효우우기타3조,시우선적치료선택.
Objective To compare the internal fixation methods for treatment of intertrochanteric fractures in elderly patients.Methods One hundred and sixty four elderly patients with intertrochanteric fractures were treated from June 2006 to September 2011.The fractures were fixed with dynamic hip screws (DHS,n =42),locking proximal femur plate (LPFP,n =40),Gamma nails (n =36) or proximal femoral nail anti-rotation (PFNA,n =46),respectively.The clinical data were collected and the operative time,blood loss,time of clinical healing,postoperative complications and Harris hip scores of 6 months after surgery were compared among groups.Results All patients were followed-up for 6 to 36 months.The operative times of DHS,LPFP,Gamma nails and PFNA groups were (103 ± 15),(90 ± 13),(79 ± 11)and (65 ±9)min,respectively(F =2.87,P <0.05).The blood loss of 4 groups was (202 ±23),(181 ±23),(98 ± 13) and (87 ± 11) ml,respectively (F =3.21,P < 0.05).The times of clinical fracture healing were (16.1±1.9),(14.6±1.8),(12.9±1.7) and (11.5±1.4) weeks,respectively(F=2.66,P<0.05).The postoperative complications of 4 groups were 4/42,3/40,2/36 and 1/46,respectively (x2 =5.67,P <0.05).The Harris hip scores of 6 months after surgery of 4 groups were 81% (34/42),85% (34/40),89% (32/36)and 93% (43/46),respectively(H =20.03,P <0.05).Conclusions In treatment for intertrochanteric fractures in elderly patients,the efficacy of intramedullary fixation (Gamma nails and PFNA) is better than extramedullary fixation DHS and LPFP).PFNA is more effective than other 3 methods and should be preferentially chosen.