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[1]胡月正,溫宏,陳彩虹,等.不同定位方式下動(dòng)力髖螺釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的對(duì)比研究[J].中醫(yī)正骨,2013,25(06):14-19.
　HU Yue-zheng*,WEN Hong,CHEN Cai-hong,et al.A retrospective trial of dynamic hip screw osteosynthesis using different positioning methods for intertrochanteric fractures of the femur in old patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(06):14-19.
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不同定位方式下動(dòng)力髖螺釘內(nèi)固定治療老年股骨轉(zhuǎn)子間 骨折的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期數(shù):
2013年06期
頁(yè)碼:
14-19
欄目:
臨床研究
出版日期:
2013-06-30

文章信息/Info

Title:
A retrospective trial of dynamic hip screw osteosynthesis using different positioning methods for intertrochanteric fractures of the femur in old patients
作者:
胡月正; 溫宏; 陳彩虹; 張宇
溫州醫(yī)科大學(xué)附屬第二醫(yī)院,浙江 溫州 325027
Author(s):
HU Yue-zheng*; WEN Hong; CHEN Cai-hong; ZHANG Yu.*
The Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325027,Zhejiang,China
關(guān)鍵詞:
髖骨折 股骨骨折 骨折固定術(shù); 內(nèi) 動(dòng)力髖螺釘
Keywords:
Hip fractures;  Femoral fractures;  Fracture fixation; internal;  Dynamic hip screw
摘要:
目的:探討不同定位方式下動(dòng)力髖螺釘內(nèi)固定術(shù)治療老年股骨轉(zhuǎn)子間骨折的臨床療效及安全性。方法:2003年4月至2009年12月,采用動(dòng)力髖螺釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折患者95例,男48例,女47例; 年齡65～87歲,中位數(shù)67歲; 骨折AO分類(lèi):A1型30例,A2型65例。其中體外導(dǎo)向器定位動(dòng)力髖螺釘固定30例,微型導(dǎo)向器定位動(dòng)力髖螺釘固定33例,傳統(tǒng)導(dǎo)向器定位動(dòng)力髖螺釘固定32例。比較3組患者的切口長(zhǎng)度、手術(shù)時(shí)間、術(shù)中失血量、術(shù)中X線透視次數(shù)、住院時(shí)間、血紅蛋白檢測(cè)值、術(shù)后疼痛程度評(píng)分、骨折愈合時(shí)間和患肢髖關(guān)節(jié)Harris評(píng)分。結(jié)果:95例患者均順利完成手術(shù),3組患者間切口長(zhǎng)度[(3.7±0.6)cm,(4.4±0.4)cm,(8.5±1.7)cm]、手術(shù)時(shí)間[(59.2±13.2)min,(59.4±12.5)min,(88.4±12.3)min]、術(shù)中失血量[(35.3±9.9)mL,(37.2±9.7)mL,(347.2±87.7)mL]、術(shù)中X線透視次數(shù)[(13.7±1.4)次,(9.2±1.9)次,(5.0±0.8)次]、住院時(shí)間[(11.4±2.1)d,(10.8±2.1)d,(15.4±2.4)d]比較,差異均有統(tǒng)計(jì)學(xué)意義(F=176.344,P=0.000; F=65.394,P=0.000; F=386.554,P=0.000; F=282.202,P=0.000; F=41.804,P=0.000); 體外導(dǎo)向器定位動(dòng)力髖螺釘固定組與微型導(dǎo)向器定位動(dòng)力髖螺釘固定組比較,切口長(zhǎng)度、手術(shù)時(shí)間、術(shù)中失血量、住院時(shí)間的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.023,P=0.959,P=0.887,P=0.294),但前者的術(shù)中X線透視次數(shù)多于后者(P=0.000); 體外導(dǎo)向器定位動(dòng)力髖螺釘固定組與傳統(tǒng)導(dǎo)向器定位動(dòng)力髖螺釘固定組比較,前者的切口長(zhǎng)度、手術(shù)時(shí)間、術(shù)中失血量、住院時(shí)間均短于(或少于)后者,術(shù)中X線透視次數(shù)多于后者(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000); 微型導(dǎo)向器定位動(dòng)力髖螺釘固定組與傳統(tǒng)導(dǎo)向器定位動(dòng)力髖螺釘固定組比較,前者切口長(zhǎng)度、手術(shù)時(shí)間、術(shù)中失血量、住院時(shí)間均短于(或少于)后者,術(shù)中X線透視次數(shù)多于后者(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000)。術(shù)前3組患者間血紅蛋白檢測(cè)值[(125.8±7.2)g·L-1,(124.7±7.9)g·L-1,(124.8±7.7)g·L-1]比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(F=0.211,P=0.801); 術(shù)后3組患者間血紅蛋白檢測(cè)值[(118.0±8.6)g·L-1,(116.9±9.2)g·L-1,(101.2±12.2)g·L-1]比較,差異有統(tǒng)計(jì)學(xué)意義(F=27.250,P=0.000),體外導(dǎo)向器定位動(dòng)力髖螺釘固定組與微型導(dǎo)向器定位動(dòng)力髖螺釘固定組間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.617),但2組患者的術(shù)后血紅蛋白檢測(cè)值均高于傳統(tǒng)導(dǎo)向器定位動(dòng)力髖螺釘固定組(P=0.000,P=0.000)。3組患者間術(shù)后疼痛數(shù)值評(píng)分[(4.1±0.9)分,(4.1±0.9)分,(6.3±1.6)分]比較,差異有統(tǒng)計(jì)學(xué)意義(F=37.610,P=0.000); 體外導(dǎo)向器定位動(dòng)力髖螺釘固定組與微型導(dǎo)向器定位動(dòng)力髖螺釘固定組間術(shù)后疼痛數(shù)值評(píng)分的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.888),但2組患者術(shù)后疼痛數(shù)值評(píng)分均低于傳統(tǒng)導(dǎo)向器定位動(dòng)力髖螺釘固定組(P=0.000,P=0.000)。3組患者間骨折愈合時(shí)間[(13.9±1.9)周,(13.7±1.8)周,(14.5±1.4)周]及患肢髖關(guān)節(jié)Harris評(píng)分[(89.6±5.8)分,(89.0±6.0)分,(89.1±6.7)分]比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(F=2.062,P=0.133; F=0.088,P=0.916)。術(shù)后體外導(dǎo)向器定位動(dòng)力髖螺釘固定組并發(fā)深靜脈血栓形成2例; 微型導(dǎo)向器定位動(dòng)力髖螺釘固定組并發(fā)深靜脈血栓形成3例; 傳統(tǒng)導(dǎo)向器定位動(dòng)力髖螺釘固定組并發(fā)切口感染1例,深靜脈血栓形成2例,髖螺釘切割1例,髖內(nèi)翻1例; 3組患者間術(shù)后并發(fā)癥發(fā)生率的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.546)。結(jié)論:不同定位方式下動(dòng)力髖螺釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的療效相當(dāng); 但與傳統(tǒng)導(dǎo)向器定位動(dòng)力髖螺釘固定術(shù)相比,體外導(dǎo)向器定位動(dòng)力髖螺釘固定術(shù)和微型導(dǎo)向器定位動(dòng)力髖螺釘固定術(shù)的切口小、手術(shù)時(shí)間短、術(shù)中失血少、住院時(shí)間短、患者痛苦小,但術(shù)中X線透視次數(shù)較多。
Abstract:
Objective:To explore the clinical curative effects and safety of dynamic hip screw(DHS)osteosynthesis using different positioning methods for intertrochanteric fractures of the femur in old patients.Methods:Ninety-five patients(48 males and 47 females)with intertrochanteric fractures of the femur,ranging in age from 65 to 87 years with a median of 67 years,were treated with DHS osteosynthesis between April 2003 and December 2009.According to AO fracture classification,30 patients were of A1 type,while 65 patients were of A2 type.Thirty patients were treated with extrasomatic guider DHS(EG-DHS),33 patients were treated with miniature guider DHS(MG-DHS)and 32 patients were treated with traditional guider DHS(TG-DHS).The 3 groups were compared with each other in such parameters as incision length,operative time,blood loss,frequency of X-ray exposure,hospital stay,hemoglobin values,postoperative numerical rating scale(NRS),fracture healing time and Harris scores of hip joint.Results:The 95 patients underwent the operation successfully,and there were statistical differences among the 3 groups in the parameters as incision length[(3.7±0.6)cm,(4.4±0.4)cm,(8.5±1.7)cm],operative time[(59.2±13.2)min,(59.4±12.5)min,(88.4±12.3)min],blood loss[(35.3±9.9)mL,(37.2±9.7)mL,(347.2±87.7)mL],frequency of X-ray exposure[(13.7±1.4),(9.2±1.9),(5.0±0.8)]and hospital stay[(11.4±2.1)d,(10.8±2.1)d,(15.4±2.4)d]respectively(F=176.344,P=0.000; F=65.394,P=0.000; F=386.554,P=0.000; F=282.202,P=0.000; F=41.804,P=0.000).There were no statistical differences in incision length,operative time,blood loss and hospital stay between EG-DHS group and MG-DHS group respectively(P=0.023,P=0.959,P=0.887,P=0.294); while the frequency of X-ray exposure of the former group were more than those of the latter group(P=0.000).The incision length,operative time,blood loss and hospital stay of EG-DHS group were all shorter(or less)than those of TG-DHS group,while the frequency of X-ray exposure of the former group were more than those of the latter group(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000).The incision length,operative time,blood loss and hospital stay of MG-DHS group were all shorter(or less)than those of TG-DHS group,while the frequency of X-ray exposure of the former group were more than those of the latter group(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000).There was no statistical difference in hemoglobin values[(125.8±7.2)g·L-1,(124.7±7.9)g·L-1,(124.8±7.7)g·L-1]among the 3 groups before the operation(F=0.211,P=0.801); while there was statistical difference in hemoglobin values[(118.0±8.6)g·L-1,(116.9±9.2)g·L-1,(101.2±12.2)g·L-1]among the 3 groups after the operation(F=27.250,P=0.000),and there was no statistical difference between EG-DHS group and MG-DHS group(P=0.617),while the postoperative hemoglobin values of above 2 groups were all higher than those of TG-DHS group(P=0.000,P=0.000).There was statistical difference in postoperative NRS[(4.1±0.9)points,(4.1±0.9)points,(6.3±1.6)points]among the 3 groups(F=37.610,P=0.000); there was no statistical difference in postoperative NRS between EG-DHS group and MG-DHS group(P=0.888),while the postoperative NRS of above 2 groups were all lower than those of TG-DHS group(P=0.000,P=0.000).There were no statistical differences in fracture healing time[(13.9±1.9)weeks,(13.7±1.8)weeks,(14.5±1.4)weeks]and Harris scores of hip joint[(89.6±5.8)points,(89.0±6.0)points,(89.1±6.7)points]among the 3 groups(F=2.062,P=0.133; F=0.088,P=0.916).After the operation,2 cases and 3 cases complicated with deep venous thrombosis were found in EG-DHS group and MG-DHS group respectively; 1 case complicated with incision infection,2 cases with deep venous thrombosis,1 case with hip screw cutting and 1 case with coxa vara were found in TG-DHS group; and there was no statistical difference in the incidence rate of postoperative complication among the 3 groups(P=0.546).Conclusion:Different positioning methods have similar curative effects in DHS osteosynthesis for intertrochanteric fractures of the femur in old patients,however,EG-DHS osteosynthesis and MG-DHS osteosynthesis have smaller incision,shorter operative time and hospital stay,less blood loss and pain while more roentgen irradiation compared with TG-DHS osteosynthesis.

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[1]李欣,胡劍鋒,王寶現(xiàn),等.股骨近端鎖定鋼板內(nèi)固定治療股骨轉(zhuǎn)子下骨折[J].中醫(yī)正骨,2012,24(01):60.

備注/Memo

備注/Memo:
基金項(xiàng)目:浙江省溫州市科技局科技項(xiàng)目(Y20110020) 通訊作者:溫宏 E-mail:[email protected]
更新日期/Last Update: 1900-01-01