四种手术方式治疗高龄骨质疏松性股骨转子间骨折的回顾性分析

发布时间：2019-07-02 21:30

【摘要】：目的探讨治疗高龄骨质疏松性股骨转子间不稳定性骨折的方法及疗效。方法对我院2005年1月至2015年5月收治的以股骨近端防旋髓内钉(PFNA)、股骨近端解剖锁定钢板(PPF-LCP)、髋关节置换术(HRP)和动力髋螺钉(DHS)手术的194例高龄骨质疏松性股骨转子间不稳定骨折患者进行回顾性研究,分别对各组的手术时间、出血量、住院时间、术后下床活动时间、Harris评分、并发症等指标进行统计学分析,评价4种治疗方法的特点及优劣。结果 PFNA组手术及住院时间最短,关节置换组次之,PF-LCP组第三,DHS组最长;PFNA组出血量最少,而关节置换组、PF-LCP组与DHS组差异无统计学意义;关节置换组离床时间最早,PFNA组次之,PF-LCP组与DHS组差异无统计学意义,术后1月的Harris评分GTF假体组明显高于其他3组,PFNA组高于PF-LCP组与DHS组,PF-LCP组高于DHS组,而术后6月的Harris评分发现无明显差异。结论对于高龄骨质疏松性股骨转子间不稳定性骨折,治疗的关键在于降低手术风险、尽早离床活动、避免术后并发症,对于身体状况尚佳、骨质疏松程度低、骨折粉碎程度轻者首选PFNA,相反,若患者合并有严重的骨质疏松、骨折部粉碎程度重则髋关节置换术更具优势,DHS需谨慎选择。
[Abstract]:Objective to investigate the method and effect of treatment of osteoporotic unstable intertrochanter fracture of the elderly. Methods from January 2005 to May 2015, 194 elderly patients with osteoporotic intertrochanteric unstable fractures were treated with (PFNA), proximal anatomical locking plate (PPF-LCP), hip replacement (HRP) and dynamic hip screw (DHS). The operation time, blood loss, hospitalization time, postoperative activity time and Harris score were analyzed. Complications and other indicators were statistically analyzed to evaluate the characteristics, advantages and disadvantages of the four treatment methods. Results the operation and hospitalization time of PFNA group was the shortest, that of joint replacement group was the second, that of PF-LCP group was the third, that of DHS group was the longest, and that of PFNA group was the least, but there was no significant difference between joint replacement group, PF-LCP group and DHS group. The departure time of joint replacement group was the earliest, that of PFNA group was the second, and there was no significant difference between PF-LCP group and DHS group. One month after operation, the Harris score of GTF group was significantly higher than that of the other three groups, PFNA group was higher than PF-LCP group and DHS group, PF-LCP group was higher than DHS group, but there was no significant difference in Harris score 6 months after operation. Conclusion the key to the treatment of osteoporotic intertrochanter unstable fractures in the elderly is to reduce the risk of operation, leave bed as soon as possible and avoid postoperative complications. PFNA, is the first choice for the patients with good physical condition, low degree of osteoporosis and light degree of fracture comminuted. If the patients have severe osteoporosis and severe comminuted degree of fracture, hip replacement is more advantageous. DHS should be carefully selected.
【作者单位】：宁夏回族自治区人民医院西夏院区骨二科;
【基金】：宁夏回族自治区科技攻关项目
【分类号】：R687.3

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