切开复位和闭合复位 DHS 内固定治疗股骨粗隆间骨折临床对比分析

摘要

目的：比较切开直视下复位动力髋螺钉（Dynamic hip screw ，DHS）内固定和C臂X线机透视下闭合复位DHS内固定两种术式治疗股骨粗隆间骨折的临床疗效。方法：回顾性分析2006年1月－2013年5月我院因股骨粗隆间骨折行DHS手术的156例患者。传统切开直视下复位DHS内固定患者90例，C臂X线机透视下闭合复位DHS内固定者66例。统计两组患者的年龄、内科基础疾病、术前风险评估、住院时间、手术时间、切口长度、术中出血量、术中透视次数、术后引流量、骨折愈合时间、术后下地负重活动时间、围手术期并发症发生率、术后患侧髋关节 Harris评分及远期生存率。结果：156例患者均获得随访，术后平均随访时间18个月。两组患者在性别、年龄、骨折类型及术前基础情况方面无显著性差异。闭合复位DHS内固定组手术切口小、手术时间短、术中术后出血量少、下床活动时间早、围手术期并发症低、负重时间早、骨折愈合快，与切开直视下复位DHS内固定手术组相比有统计学差异（P＜0.05）；切开复位组术中透视次数及解剖复位率优于闭合复位组（P＜0．05）。两组间住院时间及远期生存率方面无统计学差异（P＞0．05）。两组间术后远期髋关节活动功能Harris评分、髋关节功能优良率及远期生存率方面无统计学差异。结论：与切开直视下复位DHS内固定相比，X线透视下闭合复位DHS内固定手术具有创伤小、手术时间短、术后下地时间早、围手术期并发症发生率低及骨折愈合快等优势，值得推广。%Objective :The purpose of this study was to evaluate the clinical outcome of open reduction and dynamic hip screw (DHS) fixation compared with closed reduction under X‐ray .Methods :We undertook a retrospective study of 156 patients with intertrochanteric fractures who received DHS from January 2006 to May 2013 .There were 90 patients in open reduction and DHS fixation group ,whereas 66 patients in closed reduction and DHS fixation group .The age ,gen‐der ,internal medical diseases ,operative risk ,duration of operation ,blood loss ,intraoperative fluoroscopy frequency ,bed‐ridden time ,duration of hospitalization ,rate of complications ,time to union ,Harris hip joint functional score were recor‐ded and assessed .Results:156 patients got followed up ,average for 18 months .No difference was observed between two groups in age ,sex distributions ,type of fracture and general physical condition .Patients who received closed re‐duction and DHS fixation have less invasive incision ,shorter operation time ,less blood loss ,less complications ,earlier weight bearing ,and less fracture healing time compared with open reduction with significant difference (P< 0 .05) . There were less intraoperative fluoroscopy frequency and higher rate of anatomic reduction (P<0 .05) .No difference was found between two groups in long‐term Harris hip joint functional score and survival rate (P>0 .05) .Conclusion:Compared with open reduction and DHS fixation ,closed reduction has more advantages including less invasive ,shorter surgical time ,earlier weight bearing ,less complication and faster fracture healing ,worth promoting .