【摘要】：目的探討治療高齡骨質疏松性股骨轉子間不穩(wěn)定性骨折的方法及療效。方法對我院2005年1月至2015年5月收治的以股骨近端防旋髓內釘(PFNA)、股骨近端解剖鎖定鋼板(PPF-LCP)、髖關節(jié)置換術(HRP)和動力髖螺釘(DHS)手術的194例高齡骨質疏松性股骨轉子間不穩(wěn)定骨折患者進行回顧性研究,分別對各組的手術時間、出血量、住院時間、術后下床活動時間、Harris評分、并發(fā)癥等指標進行統(tǒng)計學分析,評價4種治療方法的特點及優(yōu)劣。結果 PFNA組手術及住院時間最短,關節(jié)置換組次之,PF-LCP組第三,DHS組最長;PFNA組出血量最少,而關節(jié)置換組、PF-LCP組與DHS組差異無統(tǒng)計學意義;關節(jié)置換組離床時間最早,PFNA組次之,PF-LCP組與DHS組差異無統(tǒng)計學意義,術后1月的Harris評分GTF假體組明顯高于其他3組,PFNA組高于PF-LCP組與DHS組,PF-LCP組高于DHS組,而術后6月的Harris評分發(fā)現(xiàn)無明顯差異。結論對于高齡骨質疏松性股骨轉子間不穩(wěn)定性骨折,治療的關鍵在于降低手術風險、盡早離床活動、避免術后并發(fā)癥,對于身體狀況尚佳、骨質疏松程度低、骨折粉碎程度輕者首選PFNA,相反,若患者合并有嚴重的骨質疏松、骨折部粉碎程度重則髖關節(jié)置換術更具優(yōu)勢,DHS需謹慎選擇。
[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.
【作者單位】： 寧夏回族自治區(qū)人民醫(yī)院西夏院區(qū)骨二科;
【基金】：寧夏回族自治區(qū)科技攻關項目
【分類號】：R687.3

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