湖南师范大学学报（医学版）
湖南師範大學學報（醫學版）
호남사범대학학보（의학판）
Journal of Hunan Normal University (Medical Science)
2015年
4期
72-74
,共3页
徐红革%王良恩%杨勇%邱志杰
徐紅革%王良恩%楊勇%邱誌傑
서홍혁%왕량은%양용%구지걸
骨质疏松%解剖型锁定钢板%股骨粗隆间骨折%股骨近端防旋髓内钉
骨質疏鬆%解剖型鎖定鋼闆%股骨粗隆間骨摺%股骨近耑防鏇髓內釘
골질소송%해부형쇄정강판%고골조륭간골절%고골근단방선수내정
osteoporosis%anatomical locking plate%intertrochanteric fracture%proximal femoral nail
目的：探讨股骨近端解剖型锁定刚板治疗老年骨质疏松性 Evan Ⅲ、Ⅳ型股骨粗隆间骨折的临床效果。方法：回顾性分析100例老年 Evan Ⅲ、Ⅳ型股骨粗隆间骨折伴骨质疏松患者，随机分为对照组和观察组，每组各50例。观察组采用切开复位股骨近端解剖型锁定钢板内固定治疗，对照组采用股骨近端髓内钉治疗。观察手术时间、术中出血量、术后下地时间、住院费用及并发症发生情况，并行 Sander 评分，术后1、3、6、12月分别复查 X 片观察骨折愈合情况和内固定位置。结果：观察组手术时间和住院费用明显低于对照组[（67.2±5.8）min 比（78.7±7.3）分）；（1.2±0.5）万比（1.9±0.8）万]，而术中出血量和术后下地时间高于对照组[（262.4±10.1）ml 比（174.2±8.8） ml ；（3.1±0.6）月比（2.4±0.7）月]，差异有统计学意义。12月末次随访，两组 Sander 评分未见统计学差异，均未发生髋内翻、内固定松动、深静脉血栓等并发症。骨折愈合时间观察组（4.6±0.3）个月，高于对照组（3.8±0.4）月。结论：股骨近端解剖型锁定刚板治疗老年骨质疏松性 Evan Ⅲ、Ⅳ型股骨粗隆间骨折手术时间短、术中出血量高、住院费用低，术后髋关节功能佳；但术后下地时间及骨折愈合时间延长，须谨慎选择患者。
目的：探討股骨近耑解剖型鎖定剛闆治療老年骨質疏鬆性 Evan Ⅲ、Ⅳ型股骨粗隆間骨摺的臨床效果。方法：迴顧性分析100例老年 Evan Ⅲ、Ⅳ型股骨粗隆間骨摺伴骨質疏鬆患者，隨機分為對照組和觀察組，每組各50例。觀察組採用切開複位股骨近耑解剖型鎖定鋼闆內固定治療，對照組採用股骨近耑髓內釘治療。觀察手術時間、術中齣血量、術後下地時間、住院費用及併髮癥髮生情況，併行 Sander 評分，術後1、3、6、12月分彆複查 X 片觀察骨摺愈閤情況和內固定位置。結果：觀察組手術時間和住院費用明顯低于對照組[（67.2±5.8）min 比（78.7±7.3）分）；（1.2±0.5）萬比（1.9±0.8）萬]，而術中齣血量和術後下地時間高于對照組[（262.4±10.1）ml 比（174.2±8.8） ml ；（3.1±0.6）月比（2.4±0.7）月]，差異有統計學意義。12月末次隨訪，兩組 Sander 評分未見統計學差異，均未髮生髖內翻、內固定鬆動、深靜脈血栓等併髮癥。骨摺愈閤時間觀察組（4.6±0.3）箇月，高于對照組（3.8±0.4）月。結論：股骨近耑解剖型鎖定剛闆治療老年骨質疏鬆性 Evan Ⅲ、Ⅳ型股骨粗隆間骨摺手術時間短、術中齣血量高、住院費用低，術後髖關節功能佳；但術後下地時間及骨摺愈閤時間延長，鬚謹慎選擇患者。
목적：탐토고골근단해부형쇄정강판치료노년골질소송성 Evan Ⅲ、Ⅳ형고골조륭간골절적림상효과。방법：회고성분석100례노년 Evan Ⅲ、Ⅳ형고골조륭간골절반골질소송환자，수궤분위대조조화관찰조，매조각50례。관찰조채용절개복위고골근단해부형쇄정강판내고정치료，대조조채용고골근단수내정치료。관찰수술시간、술중출혈량、술후하지시간、주원비용급병발증발생정황，병행 Sander 평분，술후1、3、6、12월분별복사 X 편관찰골절유합정황화내고정위치。결과：관찰조수술시간화주원비용명현저우대조조[（67.2±5.8）min 비（78.7±7.3）분）；（1.2±0.5）만비（1.9±0.8）만]，이술중출혈량화술후하지시간고우대조조[（262.4±10.1）ml 비（174.2±8.8） ml ；（3.1±0.6）월비（2.4±0.7）월]，차이유통계학의의。12월말차수방，량조 Sander 평분미견통계학차이，균미발생관내번、내고정송동、심정맥혈전등병발증。골절유합시간관찰조（4.6±0.3）개월，고우대조조（3.8±0.4）월。결론：고골근단해부형쇄정강판치료노년골질소송성 Evan Ⅲ、Ⅳ형고골조륭간골절수술시간단、술중출혈량고、주원비용저，술후관관절공능가；단술후하지시간급골절유합시간연장，수근신선택환자。
ObjectiveTo investigate the anatomical proximal femur in the treatment of osteoporotic Evan Ⅲ, Ⅳ intertro-chanteric fractures of the clinical effects of locking rigid board. Methods 100 casesge (>65y) with osteoporosis and Evan Ⅲ,Ⅳ intertrochanteric fractures in our hospital were retrospective analyzed. They were randomly divided into control group and observation group, each group of 50 cases. The observation group was treated with open reduction and proximal femoral locking plate fixation, and the control group with the proximal femur intramedullary nail fixation. The operation time, bleeding volume, postoperative ambulation time, cost of hospitalization and complications were observed. The Sander score were calculated after 12 months. The X-ray were reviewed after 1, 3, 6, 12 months respectively.Results The operation time and cost of hospitali-zation in the observation group were significantly lower than the control group[(67.2±5.8)min vs (78.7±7.3)min); (1.2±0.5) million vs (1.9±0.8) million], the operative bleeding and postoperative time in e observation group were higher thanhe control group[(262.4±10.1) mL vs (174.2±8.8) mL; (3.1±0.6) months vs (2.4±0.7) months], the difference was statistically significant. There was no significant difference of the Sander score after the 12th month follow-up between the two groups There were no coxa vara, internal fixation loosening, deep vein thrombosis in the two groups. The healing time of fracture in the observation group was higher than that of the control group[(4.6±0.3) months vs (3.8±0.4) months]. Conclusion the anatomical proximal femur in the treatment of osteoporotic Evan Ⅲ, Ⅳ femoral intertrochanteric fracture with shorter operation time, less bleeding, hospitalization expenses low locking rigid plate, but the postoperative ambulation time and fracture healing time, must be careful selection of patients.
