老年患者股骨粗隆間骨折內固定治療_《華西醫學》

作者：

楊靈 , 龍成 , 徐巍 ,  劉躍洪 , 汪紅 , 雷達

德陽市人民醫院骨科（四川德陽，618000）;

關鍵詞：

高齡患者股骨粗隆間骨折內固定手術方法

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目的　回顧分析不同內固定方式對老年股骨粗隆間骨折的臨床療效。方法　1999年3月－2009年5月采用內固定手術治療121例股骨粗隆間骨折患者，根據內固定方式不同分為4組：動力髖螺釘（DHS；A組43例）、經皮加壓鋼板（PCCP；B組19例）、股骨近端髓內釘（PFN；C組27例）、Gamma釘（D組32例）。4組患者年齡、骨折類型（Tronzo-Evans分型）等一般資料比較差異無統計學意義（P＞0.05），具有可比性。記錄手術時間、術中出血量及術后引流量、術中術后并發癥、骨折臨床愈合時間、術后髖關節功能恢復程度，比較評價各組臨床療效。結果　術后各組患者切口均Ⅰ期愈合，無傷口感染等早期并發癥發生。患者均獲隨訪，隨訪時間18～108個月，平均56.4個月。與A組比較，B、C、D組手術時間明顯縮短，術中出血量及術后引流量減少，骨折愈合時間縮短，差異均有統計學意義（P＜0.01），A組較差；B、C、D各組間兩兩比較差異無統計學意義（P＞0.05）。術后并發癥發生率A組較高，與其余各組比較差異有統計學意義（P＜0.05）。末次隨訪時各組髖關節功能Harris評分比較差異無統計學意義（P＞0.05）。結論　B、D組及C組3種手術方法在治療老年患者股骨粗隆間骨折具有創傷小、并發癥少等優勢，與A組法比較更有利于老年患者術后康復，但應注意骨折的良好復位及內固定物位置。

引用本文： 楊靈,龍成,徐巍,劉躍洪,汪紅,雷達. 老年患者股骨粗隆間骨折內固定治療. 華西醫學, 2012, 27(12): 1844-1847. doi: 復制

1.	Liporace FA，Egol KA, Tejwani N, et al. What’s new in hip fractures? Current concepts[J]. Am J Orthop (Belle Mead NJ), 2005, 34(2): 66-74.
2.	Jesen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis[J]. Acta Orthop Scand, 1975, 46(5): 795-803.
3.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg (Am), 1969, 51(4): 737-755．.
4.	Doruk H, Mas MR, Yildiz C, et al. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly[J]. Arch Gerontol Geriatr, 2004, 39(2): 179-185．.
5.	Zuckerman JD, Skovron ML, Koval KJ, et al. Postoperative complications and mortality associated with operative delay in older patients who have fracture of the hip[J]. J Bone Joint Surg (Am), 1995, 77(10): 1551-1556.
6.	張長青. 關于老年股骨轉子間骨折的當代觀點[J]. 中華骨科雜志, 2012, 32(7): 611-613.
7.	張英澤, 王慶賢, 潘進社, 等. 微創動力髖螺釘(DHS)治療老年股骨轉子間骨折[J].中華創傷骨科雜志, 2005, 7 (4) : 318-321.
8.	Alobaid A, Harvey EJ, Elder GM, et al. Minimally invasive dynamic hip screw: prospective randomized trial of two techniques of insertion of a standard dynamic fixation device[J]. J Orthop Trauma, 2004, 18(4): 207-212.
9.	李必奎,陳周兵,徐富生.股骨近端鎖定鋼板治療股骨轉子間骨折[J].中國修復重建外科雜志, 2011, 25(10): 1273-1275.
10.	Ramakrishnan M, Prasad SS, Parkinson RW, et al. Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail.Injury[J]. 2004, 35(2): 184-190.
11.	李雪峰, 姜為民, 王璐, 等. 4種內固定方式治療股骨轉子間骨折的療效對比[J].臨床骨科雜志, 2009, 12(3): 302-304.
12.	Werner-Tutschku W, Lajtai G, Schmiedhuber G, et al. Intra-and perioperative complications in the stabilization of per-and subtrochanteric femoral fractures by means of PFN[J]．Unfallchirurg, 2002, 105(10): 881-885．.
13.	Banan H, Al-sabti A, Jimulia T, et al. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN) our first 60 cases [J]. Injury, 2002, 33(5): 401-405.
14.	Kosygan KP, Mohan R, Newman RJ. The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip[J]. J Bone Joint Surg (Br), 2002, 84(1):19-22.
15.	陳濱, 王鋼, 黎潤光. 經皮加壓鋼板微創內固定治療股骨轉子間骨折的初步體會并文獻復習[J].中華創傷骨科雜志, 2009, 11(3): 233-235.
16.	Gotfried Y. Percutaneous compression plating for intertrochanteric hip fractures: treatment rationale[J]. Orthopedics, 2002, 25(6): 647-652.

1. 　Liporace FA，Egol KA, Tejwani N, et al. What’s new in hip fractures? Current concepts[J]. Am J Orthop (Belle Mead NJ), 2005, 34(2): 66-74.
2. 　Jesen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis[J]. Acta Orthop Scand, 1975, 46(5): 795-803.
3. 　Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg (Am), 1969, 51(4): 737-755．.
4. 　Doruk H, Mas MR, Yildiz C, et al. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly[J]. Arch Gerontol Geriatr, 2004, 39(2): 179-185．.
5. 　Zuckerman JD, Skovron ML, Koval KJ, et al. Postoperative complications and mortality associated with operative delay in older patients who have fracture of the hip[J]. J Bone Joint Surg (Am), 1995, 77(10): 1551-1556.
6. 　張長青. 關于老年股骨轉子間骨折的當代觀點[J]. 中華骨科雜志, 2012, 32(7): 611-613.
7. 　張英澤, 王慶賢, 潘進社, 等. 微創動力髖螺釘(DHS)治療老年股骨轉子間骨折[J].中華創傷骨科雜志, 2005, 7 (4) : 318-321.
8. 　Alobaid A, Harvey EJ, Elder GM, et al. Minimally invasive dynamic hip screw: prospective randomized trial of two techniques of insertion of a standard dynamic fixation device[J]. J Orthop Trauma, 2004, 18(4): 207-212.
9. 　李必奎,陳周兵,徐富生.股骨近端鎖定鋼板治療股骨轉子間骨折[J].中國修復重建外科雜志, 2011, 25(10): 1273-1275.
10. 　Ramakrishnan M, Prasad SS, Parkinson RW, et al. Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail.Injury[J]. 2004, 35(2): 184-190.
11. 　李雪峰, 姜為民, 王璐, 等. 4種內固定方式治療股骨轉子間骨折的療效對比[J].臨床骨科雜志, 2009, 12(3): 302-304.
12. 　Werner-Tutschku W, Lajtai G, Schmiedhuber G, et al. Intra-and perioperative complications in the stabilization of per-and subtrochanteric femoral fractures by means of PFN[J]．Unfallchirurg, 2002, 105(10): 881-885．.
13. 　Banan H, Al-sabti A, Jimulia T, et al. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN) our first 60 cases [J]. Injury, 2002, 33(5): 401-405.
14. 　Kosygan KP, Mohan R, Newman RJ. The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip[J]. J Bone Joint Surg (Br), 2002, 84(1):19-22.
15. 　陳濱, 王鋼, 黎潤光. 經皮加壓鋼板微創內固定治療股骨轉子間骨折的初步體會并文獻復習[J].中華創傷骨科雜志, 2009, 11(3): 233-235.
16. 　Gotfried Y. Percutaneous compression plating for intertrochanteric hip fractures: treatment rationale[J]. Orthopedics, 2002, 25(6): 647-652.

《華西醫學》

老年患者股骨粗隆間骨折內固定治療

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《華西醫學》

老年患者股骨粗隆間骨折內固定治療

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