摘要
目的：探讨动力髋部螺钉(Dinamic Hip Screw，DHS)和动力髁部螺钉(Dinamic Condyle Screw，DCS)以及股骨近端髓内钉(Proximal Femoral Nail，PFN)治疗股骨粗隆间部骨折的适应症及其临床疗效。资料与方法：1．一般资料：对我院2004．8～2006．3收治的老年性股骨粗隆间骨折患者，随机抽取38例，均为行走摔伤，有17例合并有内科杂病，合并有冠心病者5例，高血压者6例，糖尿病者4例，既有冠心病又有高血压者2例。其中，DHS内固定治疗者19例，男6例，女13例；年龄61—83岁，平均72岁。此组均为Evans分类第一类骨折(其中，Ⅱ型2例，ⅢA型9例，ⅢB型6例，Ⅳ型2例)。DCS内固定者12例，男4例，女8例，平均年龄75岁，此组均为Evans分类第二类骨折，即逆粗隆间骨折。PFN治疗7例，男2例，女5例，平均年龄74岁，均为粗隆间粉碎骨折。结果：1．所有病例均获6个月～2年的随访，平均随访1年半。三组病人中有37例于术后3～6个月拍片复查达骨性愈合，关节活动度好，无髋内翻畸形及股骨头缺血性坏死等并发症发生；其中1例，于术后2年因心脏病死亡，但于术后1年拍片示，骨折已骨性愈合。2．DHS内固定组平均手术时间90分钟，术中平均出血量435ml，术中平均输血量485ml，术后平均愈合时间12.6月；DCS内固定组平均手术时间85分钟，术中平均出血量440ml，术中平均输血量466ml，术后平均愈合时间13.1月；PFN内固定组平均手术时间55分钟，术中平均出血量65ml，术中均未输血，术后平均愈合时间11.9月。结论：1．DHS、DCS和PFN内固定治疗老年性股骨粗隆间骨折均可获得满意疗效，但应严格掌握手术适应症，术中根据其特点采取相应的处理，围手术期应积极预防以减少并发症的发生。2．DHS、DCS在手术时间，术中失血量，术中输血量，术后并发症的发生率以及术后骨折愈合时间上无明显差异；PFN与上述两组在术后并发症的发生率和术后骨折愈合时间上无明显差异，但在手术时间，术中失血量，术中输血量上存在明显差异。3．DHS、DCS和PFN三组在内固定术后1年左右均达骨性愈合，Harris髋关节功能评分均达优良，在统计学上无明显差异(P＞0.05)。
Backgroud: Most intertrochanteric fracture occure in eldly inviduals. The incidence of intertrochanteric fracture is increasing, not unexpectedly, since the general life expectancy of the population has increased significantly during the last few decades. Operative treatment can decrease complication and motality rate and the paient can recover early. DHS、 DCS and PFN are ideal implants for treatment of intertrochanteric fracture at present. Objective: To study the effects and indications of dinamic hip screw (DHS) , dynamic condyle screw (DCS) and proximal femoral nail, (PFN) for treatment of senile femoral intertrochanteric fracture. Materials and Methods: Tirty eightcases with femoral intertrochanteric fracture. From 2004.9 to 2006.3 in our hospital were divided to three groups according to different indications. All patients were treated surgically, nineteen with DHS , twelve with DCS and seven with PFN. Result: All the patients were followed up from six months to two years, the healing time and the function of the hip joint after operation of DHS 、 DCS and PFN were no obvipus difference. Conclusion: 1.The senile patients with femoral intertrochanteric fracture need surgically treatment. DHS , DCS and PFN can be good methods to the intertrochanteric fractures in the eldly, but the operation indication should be chosen strictly 2.The operation time, blood transfusion,the bleed quantity in operation,complications and the healing time of fracture of DHS and DCS were no obvipus difference; PFN has no obvipus difference in complication and the healing time of fracture with DHS and DCS, but has obvious diference in operation time, blood transfusion,and the bleed quantity in operation.3.The Harris Hip Score(HHS) have no difference after a year of operation with DHS, DCS and PFN.
引文
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