股骨近端锁定钢板治疗老年股骨粗隆间骨折的对比研究

摘要

目的:比较动力髋螺钉(DHS)、髓内固定(IF)、股骨近端锁定钢板(PF-LCP)治疗老年股骨粗隆间骨折的疗效,探讨各自的手术适应证.方法:回顾性分析2000年7月至2009年8月采用DHS、IF、PF-LCP治疗老年股骨粗隆间复杂骨折165例,其中DHS组58例,男30例,女28例,平均年龄71岁;骨折根据Jensen分型:Ⅱ型30例,Ⅲ型28例;IF组65例,男35例,女30例,平均年龄73岁;Ⅱ型37例,Ⅲ型28例;PF-LCP组42例,男23例,女19例,平均年龄74岁;Ⅱ型22例,Ⅲ型20例.对3组患者的术中情况、术后功能及并发症等情况进行比较.结果:165例患者术后获得随访,时间8～18个月,平均14.8个月.在切口长度、手术时间上,IF组较DHS组和PF-LCP组均短,DHS组与PF-LCP组差异无统计学意义.在出血量、功能锻炼时间及骨折愈合时间上,IF组、PF-LCP组均较DHS组少或短,而IF组与PF-LCP组差异无统计学意义.术后功能疗效方面,IF组、PF-LCP组均较DHS组好,差异均有统计学意义.术后并发症方面,PF-LCP组明显少于IF组和DHS组.结论:PF-LCP治疗老年复杂不稳定的股骨粗隆间骨折在疗效及并发症方面有明显优势,尤其对骨折严重粉碎、骨质疏松患者,更有利于骨折愈合和功能恢复,并发症少.%Objective:To compare the clinic outcomes of dynamic hip screw (DHS), intramedullary fixation (IF) and proximal femur locking plate (PF-LCP) in the treatment of intertrochanteric fractures in the elderly patients. Methods: From July 2000 to August 2009, 165 old patients with intertrochanteric fractures were treated respectively by DHS,IF,PF-LCP. Fifty-eight patients were in DHS group including 30 males and 28 females with an average age of 71 years old; there were 30 cases of type Ⅱ fracture of Jensen, 28 cases of type Ⅲ fracture. Sixty-five patients were in IF group including 35 males and 30 females with an average age of 73 years old; there were 37 cases of type Ⅱ fracture of Jensen,28 cases of type Ⅲ fracture. Forty-two patients were in PF-LCP group including 23 males and 19 females with an average age of 74 years old; there were 22 cases of type Ⅱ fracture of Jensen, 20 cases of type Ⅲ fracture. The operative procedures,complications and therapeutic effects were compared among 3 groups. Results:All patients were followed up from 15 to 21 months (averaged 18.3 months). The incision length and the operation time of IF group were shorter than that of DHS and PF-LCP,but there were no significant difference between DHS group and PF-LCP group. The intraoperattive blood loss,rehabilitation and healing time of IF and PF-LCP were less or shorter than that of DHS group,but there were no significant difference between IF group and PF-LCP group. The functional recovery of IF group and PF-LCP were better than that of DHS group,there were significant difference among 3 groups.The complications of PF-LCP group was fewer than that of IF group and DHS group. Conclusion:PF-LCP is the credible method for intertrochanteric fractures in the elderly patients,especially for severe comminuted fracture and osteoporosis,for it can reduce operation complications and benefit for fracture healing and hip functional recovery.