不同方法治疗老年股骨转子间合并转子下骨折的比较
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摘要
目的比较不同方法治疗老年股骨转子间合并转子下骨折的临床疗效,以期为该类型骨折的临床治疗提供参考。方法回顾性分析2013年3月至2017年3月在河北医科大学第三医院及围场县医院治疗的51例老年股骨转子间合并转子下骨折的患者资料,其中男性21例(41.2%),女性30例(48.8%);平均年龄(71±4)岁。分别采用了股骨近端锁定接骨板(PFLP,18例)、重建髓内钉(RIN,16例)及股骨近端防旋髓内钉(PFNA,17例)内固定治疗方法。比较三组患者在性别、年龄、骨折患侧、术前牵引天数、手术时间、手术出血量、全部切口长度、骨折愈合时间、手术并发症、术后髋关节功能评分等方面的差异。结果 51例患者获得满意随访,随访率100%。随访时间12～44个月。PFLP组平均手术时间为(155±27)min、全部切口长度为(20.8±2.6)cm、术中出血量为(274±36)ml、术后引流量为(87±20)ml;RIN组平均手术时间为(122±16)min、所有切口长度为(11.8±1.5)cm、术中出血量为(144±43)ml、隐性失血量为(428±16)ml、出血总量为(558±16)ml;PFNA组平均手术时间为(44.4±4.2)min、所有切口长度为(8.5±0.6)cm、术中出血量为(94±24)ml、隐性失血量为(408±36)ml、出血总量为(520±24)ml。在手术时间、切口长度、术中出血量等方面,PFNA组均低于PFLP组和RIN组,PFLP组的术后引流量明显高于PFNA组和RIN组(P<0.01);PFNA组和RIN组的手术总出血量高于PFLP组(P<0.05)。PFLP组骨折愈合时间为(16.2±2.5)w,高于RIN组[(14.9±1.1)w]和PFNA组[(14.2±1.5)w],差异有统计学意义(F=5.224,P<0.05)。PFLP组的术后第12个月Harris评分[(80±7)分]低于RIN组[(88±4)分]和PFNA组[(91±4)分],差异有统计学意义(F=19.673,P<0.01)。结论本研究中所采用的3种固定方式中,PFNA与PFLP及RIN相比,具有手术切口小、手术时间短、术中出血少、骨折愈合所需时间短、术后髋关节功能恢复好的优点,是治疗老年股骨转子间骨折合并转子下骨折的理想固定方式。
Objective To compare the clinical efficacy of different methods in the treatment of femoral intertrochanteric-subtrochanteric fractures in the elderly,and provide reference for the clinical treatment of this type of fracture.Methods A retrospective analysis of 51 elderly patients with femoral intertrochanteric and subtrochanteric fractures treated in the Third Hospital of Hebei Medical University and Weichang County Hospital from March 2013 to March 2017,including 21 males(41.2%),females 30 cases(48.8%);age(71±4)years.The proximal femoral locking plate(PFLP),reconstructed intramedullary nail(RIN),and proximal femoral anti-rotation intramedullary nail(PFNA)were used.Differences of gender,age,fracture side,preoperative traction days,operation time,surgical bleeding volume,total incision length,fracture healing time,surgical complications,and postoperative hip function score were compared.Results 51 patients were followed up satisfactorily and last for 12 to 44 months.The follow-up rate was 100%.The average operation time of the PFLP group was(155±27)min,the length of all incisions was(20.8±2.6)cm,the intraoperative blood loss was(274±36)ml,and the postoperative drainage volume was(87±20)ml.The average operation time was(122±16)min,the length of all incisions was(11.8±1.5)cm,the intraoperative blood loss was(144±43)ml,the recessive blood loss was(428±16)ml,and the total amount of bleeding was(558±16)ml;the average operation time of the PFNA group was(44.4±4.2)min,the length of all incisions was(8.5±0.6)cm,the intraoperative blood loss was(94±24)ml,and the recessive blood loss was(408±3 6)ml and the total amount of bleeding is(520±24)ml.In the operative time,length of incision,intraoperative blood loss,PFNA group was lower than PFLP group and RIN group.The postoperative drainage volume of PFLP group was significantly higher than that of PFNA group and RIN group(P<0.01);PFNA group and RIN group The total amount of bleeding in the surgery group was higher than that in the PFLP group(P<0.05).The fracture healing time of PFLP group was(16.2±2.5)w higher than RIN(14.9±1.1)w and PFNA group(14.2±1.5)w,the difference was statistically significant(F=5.224,P<0.05).The Harris score(80±7)in the PFLP group was lower than that in the RIN group(88±4)and the PFNA group(91±4).The difference was statistically significant(F=19.673,P<0.01).).Conclusions Among the three fixation methods used in this study,PFNA has a smaller surgical incision,shorter operative time,less intraoperative blood loss,shorter time to fracture healing,and better postoperative hip function recovery than PFLP and RIN.The advantage is an ideal fixation method for the treatment of intertrochanteric fractures in the elderly with subtrochanteric fractures.
Objective To compare the clinical efficacy of different methods in the treatment of femoral intertrochanteric-subtrochanteric fractures in the elderly,and provide reference for the clinical treatment of this type of fracture.Methods A retrospective analysis of 51 elderly patients with femoral intertrochanteric and subtrochanteric fractures treated in the Third Hospital of Hebei Medical University and Weichang County Hospital from March 2013 to March 2017,including 21 males(41.2%),females 30 cases(48.8%);age(71±4)years.The proximal femoral locking plate(PFLP),reconstructed intramedullary nail(RIN),and proximal femoral anti-rotation intramedullary nail(PFNA)were used.Differences of gender,age,fracture side,preoperative traction days,operation time,surgical bleeding volume,total incision length,fracture healing time,surgical complications,and postoperative hip function score were compared.Results 51 patients were followed up satisfactorily and last for 12 to 44 months.The follow-up rate was 100%.The average operation time of the PFLP group was(155±27)min,the length of all incisions was(20.8±2.6)cm,the intraoperative blood loss was(274±36)ml,and the postoperative drainage volume was(87±20)ml.The average operation time was(122±16)min,the length of all incisions was(11.8±1.5)cm,the intraoperative blood loss was(144±43)ml,the recessive blood loss was(428±16)ml,and the total amount of bleeding was(558±16)ml;the average operation time of the PFNA group was(44.4±4.2)min,the length of all incisions was(8.5±0.6)cm,the intraoperative blood loss was(94±24)ml,and the recessive blood loss was(408±3 6)ml and the total amount of bleeding is(520±24)ml.In the operative time,length of incision,intraoperative blood loss,PFNA group was lower than PFLP group and RIN group.The postoperative drainage volume of PFLP group was significantly higher than that of PFNA group and RIN group(P<0.01);PFNA group and RIN group The total amount of bleeding in the surgery group was higher than that in the PFLP group(P<0.05).The fracture healing time of PFLP group was(16.2±2.5)w higher than RIN(14.9±1.1)w and PFNA group(14.2±1.5)w,the difference was statistically significant(F=5.224,P<0.05).The Harris score(80±7)in the PFLP group was lower than that in the RIN group(88±4)and the PFNA group(91±4).The difference was statistically significant(F=19.673,P<0.01).).Conclusions Among the three fixation methods used in this study,PFNA has a smaller surgical incision,shorter operative time,less intraoperative blood loss,shorter time to fracture healing,and better postoperative hip function recovery than PFLP and RIN.The advantage is an ideal fixation method for the treatment of intertrochanteric fractures in the elderly with subtrochanteric fractures.
引文
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14钟俊青,王连成.快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究[J/CD].中华老年骨科与康复电子杂志,2016,2(2):87-91.
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23 Leblanc ES,Hillier TA,Pedula KL,et al.Hip fracture and increased short-term but not long-term mortality in healthy older women[J].Arch Intern Med,2011,171(20):1831-1837.
24中国疾病预防控制中心慢性非传染性疾病预防控制中心.中国死因监测数据集2013[M].北京:科学普及出版社,2015:62.
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27林华.骨质疏松髋部骨折与生活方式管理[J].中国临床医生,2013,41(6):9-11.
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30 Karagiannis A,Papakitsou E,Dretakis K,et al.Mortality rates of patients with a hip fracture in a southwestern district of Greece:Tenyear follow-up with reference to the type of fracture[J].Calcif Tissue Int,2006,78(2):72-77.
31张健,蒋协远,黄晓文.1139例老年髋部骨折治疗及流行病学分析[J].中国医刊,2016,51(6):91-94.
32王鹏建,张超,阮狄克,等.股骨粗隆间骨折的外科治疗策略及疗效分析[J].中国骨与关节损伤杂志,2008,23(12):969-971.
33彭成忠,肖涛,陈湘,等.闭合复位Gamma钉治疗高龄股骨粗隆骨折[J].实用骨科杂志,2004,10(3):267-268.
34 Radford PJ,Needoff M,Webb JK.A prospective randomized comprision of the dynamic hip screw and the gamma locking nail[J].J Bone Joint Surg Br,1993,75(5):789-793.
35 Harrington KD,Johnston JO.The management of comminuted unstable intertrochanteric fractures[J].J Bone Joint Surg Am,1973,55(7):1367-1376.
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2廖红波,田野.解剖型锁定钢板固定治疗股骨粗隆部粉碎骨折[J].实用骨科杂志,2011,17(3):250-252.
3王亦璁.骨与关节损伤[M].第3版.北京:人民卫生出版社,2001:866.
4 Gross JB.Estimating allowable blood loss:corrected for dilution[J].Anesthesiology,1983,58(3):277-280.
5刘建恒,张里程,唐佩福.骨折延迟愈合和不愈合的诊治现状[J].中华外科杂志,2015,53(6):464-467.
6 Nonunion MJ.Pseudarthrosis of fracture healing.a histopathologic study of 95 human specimens[J].Clin Orthop Relat Res,1991(251):203-213.
7 Xue D,Yu J,Zheng Q,et al.The treatment strategies of intertrochanteric fractures nonunion:An experience of 23 nonunion patients[J].Injury,2017,48(3):708-714.
8 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.
9 Koval KJ,Aharonoff GB,Rokito AS,et al.Patients with femoarl neck and intertrochntericfractures:Are the same?[J].Clin Orthop Relat Res,1996,330:166-172.
10郭晖艳,韩俊江.我国人口老龄化的特点及应对措施[J].劳动保障世界,2012,2(4):34-37.
11 Chen W,Lv HZ,Liu S,et al.National incidence of traumatic fractures in China:a retrospective survey of 512 187 individuals[J].LANCET GLOBAL HEALTH,2017,5(8):E807-E817.
12 Jain R,Basinski A,Kreder HJ.Nonoperative treatment of hip fractures[J].Int Orthop,2003,27(1):11-17.
13 Shiga T,Wajima Z,Ohe Y.Is operative delay associated with increased mortality of hip fracture patients? Systematic review,metaanalysis,and meta-regression[J].Can J Anaesth,2008,55(3):146-154.
14钟俊青,王连成.快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究[J/CD].中华老年骨科与康复电子杂志,2016,2(2):87-91.
15张强,陈伟,张奇,等.早期干预预防股骨颈骨折并发症的临床研宄[J].河北医药,2009,31(2):226-226.
16 Colon-Emeric C,Kuchibhatla M,Pieper C,et al.The contribution of hip fracture to risk of subsequent fractures:data from two longitudinal studies[J].Osteoporo Int,2003,14(11):879-883.
17 Association of Anaesthetists of Great Britain and Ireland,Griffiths R,Alper J,Beckingsale A,Goldhill D,et al.Management of proximal femoral fractures 2011:Association of Anaesthetists of Great Britain and Ireland[J].Anaesthesia,2012,67(1):85-98.
18裴福兴,邱贵兴.骨质疏松性骨折的临床诊断与治疗[M].北京:人民卫生出版社,2007:38-42.
19 Bottle A,Aylin P.Mortality associated with delay in operation after hip fracture:observational study[J].BMJ,2006,332(7547):947-951.
20 Abrahamsen B,Van Staa T,Ariely R,et al.Excess mortality following hip fracture:a systematic epidemiological review[J].Osteoporo Int,2009,20(10):1633-1650.
21 Mak JC,Cameron ID,March LM,et al.Evidence-based guidelines for the management of hip fractures in older persons:an update[J].Med J Aust,2010,192(1):37-41.
22 Cram P,Lu X,Kaboli PJ,et al.Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty,1991-2008[J].JAMA,2011,305(15):1560-1567.
23 Leblanc ES,Hillier TA,Pedula KL,et al.Hip fracture and increased short-term but not long-term mortality in healthy older women[J].Arch Intern Med,2011,171(20):1831-1837.
24中国疾病预防控制中心慢性非传染性疾病预防控制中心.中国死因监测数据集2013[M].北京:科学普及出版社,2015:62.
25贺彩霞,曲美岩,贺永萍.延续护理对老年髋部骨折患者术后功能恢复的影响[J].中国医刊,2014,49(8):103-104.
26王桢,赵兴山,孙华毅.老年髋部骨折围术期心功能不全患者E/e'的应用研究[J].中国医刊,2015,50(12):27-29.
27林华.骨质疏松髋部骨折与生活方式管理[J].中国临床医生,2013,41(6):9-11.
28李永,胡振忠,李东超,等.老年髋部骨折手术治疗与非手术治疗患者的耐受性分析及手术影响因素探讨[J].中国临床医生杂志,2015,43(12):66-69.
29王培文,李毅中,林金矿,等.脆性髋部骨折的近期死亡率及相关危险因素研究[J].中华骨科杂志,2014,34(7):730-735.
30 Karagiannis A,Papakitsou E,Dretakis K,et al.Mortality rates of patients with a hip fracture in a southwestern district of Greece:Tenyear follow-up with reference to the type of fracture[J].Calcif Tissue Int,2006,78(2):72-77.
31张健,蒋协远,黄晓文.1139例老年髋部骨折治疗及流行病学分析[J].中国医刊,2016,51(6):91-94.
32王鹏建,张超,阮狄克,等.股骨粗隆间骨折的外科治疗策略及疗效分析[J].中国骨与关节损伤杂志,2008,23(12):969-971.
33彭成忠,肖涛,陈湘,等.闭合复位Gamma钉治疗高龄股骨粗隆骨折[J].实用骨科杂志,2004,10(3):267-268.
34 Radford PJ,Needoff M,Webb JK.A prospective randomized comprision of the dynamic hip screw and the gamma locking nail[J].J Bone Joint Surg Br,1993,75(5):789-793.
35 Harrington KD,Johnston JO.The management of comminuted unstable intertrochanteric fractures[J].J Bone Joint Surg Am,1973,55(7):1367-1376.
36王金河,朱大木.麦氏鹅头三翼钉治疗股骨转子骨折八例报告[J].中华骨科杂志,1994,14:778.
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