[1]胡月正,温宏,陈彩虹,等.不同定位方式下动力髋螺钉内固定治疗老年股骨转子间骨折的对比研究[J].中医正骨,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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不同定位方式下动力髋螺钉内固定治疗老年股骨转子间 骨折的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期数:
2013年06期
页码:
14-19
栏目:
临床研究
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; 温宏; 陈彩虹; 张宇
温州医科大学附属第二医院,浙江 温州 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
关键词:
髋骨折 股骨骨折 骨折固定术; 内 动力髋螺钉
Keywords:
Hip fractures;  Femoral fractures;  Fracture fixation; internal;  Dynamic hip screw
摘要:
目的:探讨不同定位方式下动力髋螺钉内固定术治疗老年股骨转子间骨折的临床疗效及安全性。方法:2003年4月至2009年12月,采用动力髋螺钉内固定治疗老年股骨转子间骨折患者95例,男48例,女47例; 年龄65～87岁,中位数67岁; 骨折AO分类:A1型30例,A2型65例。其中体外导向器定位动力髋螺钉固定30例,微型导向器定位动力髋螺钉固定33例,传统导向器定位动力髋螺钉固定32例。比较3组患者的切口长度、手术时间、术中失血量、术中X线透视次数、住院时间、血红蛋白检测值、术后疼痛程度评分、骨折愈合时间和患肢髋关节Harris评分。结果:95例患者均顺利完成手术,3组患者间切口长度[(3.7±0.6)cm,(4.4±0.4)cm,(8.5±1.7)cm]、手术时间[(59.2±13.2)min,(59.4±12.5)min,(88.4±12.3)min]、术中失血量[(35.3±9.9)mL,(37.2±9.7)mL,(347.2±87.7)mL]、术中X线透视次数[(13.7±1.4)次,(9.2±1.9)次,(5.0±0.8)次]、住院时间[(11.4±2.1)d,(10.8±2.1)d,(15.4±2.4)d]比较,差异均有统计学意义(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); 体外导向器定位动力髋螺钉固定组与微型导向器定位动力髋螺钉固定组比较,切口长度、手术时间、术中失血量、住院时间的差异均无统计学意义(P=0.023,P=0.959,P=0.887,P=0.294),但前者的术中X线透视次数多于后者(P=0.000); 体外导向器定位动力髋螺钉固定组与传统导向器定位动力髋螺钉固定组比较,前者的切口长度、手术时间、术中失血量、住院时间均短于(或少于)后者,术中X线透视次数多于后者(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000); 微型导向器定位动力髋螺钉固定组与传统导向器定位动力髋螺钉固定组比较,前者切口长度、手术时间、术中失血量、住院时间均短于(或少于)后者,术中X线透视次数多于后者(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000)。术前3组患者间血红蛋白检测值[(125.8±7.2)g·L-1,(124.7±7.9)g·L-1,(124.8±7.7)g·L-1]比较,差异无统计学意义(F=0.211,P=0.801); 术后3组患者间血红蛋白检测值[(118.0±8.6)g·L-1,(116.9±9.2)g·L-1,(101.2±12.2)g·L-1]比较,差异有统计学意义(F=27.250,P=0.000),体外导向器定位动力髋螺钉固定组与微型导向器定位动力髋螺钉固定组间的差异无统计学意义(P=0.617),但2组患者的术后血红蛋白检测值均高于传统导向器定位动力髋螺钉固定组(P=0.000,P=0.000)。3组患者间术后疼痛数值评分[(4.1±0.9)分,(4.1±0.9)分,(6.3±1.6)分]比较,差异有统计学意义(F=37.610,P=0.000); 体外导向器定位动力髋螺钉固定组与微型导向器定位动力髋螺钉固定组间术后疼痛数值评分的差异无统计学意义(P=0.888),但2组患者术后疼痛数值评分均低于传统导向器定位动力髋螺钉固定组(P=0.000,P=0.000)。3组患者间骨折愈合时间[(13.9±1.9)周,(13.7±1.8)周,(14.5±1.4)周]及患肢髋关节Harris评分[(89.6±5.8)分,(89.0±6.0)分,(89.1±6.7)分]比较,差异均无统计学意义(F=2.062,P=0.133; F=0.088,P=0.916)。术后体外导向器定位动力髋螺钉固定组并发深静脉血栓形成2例; 微型导向器定位动力髋螺钉固定组并发深静脉血栓形成3例; 传统导向器定位动力髋螺钉固定组并发切口感染1例,深静脉血栓形成2例,髋螺钉切割1例,髋内翻1例; 3组患者间术后并发症发生率的差异无统计学意义(P=0.546)。结论:不同定位方式下动力髋螺钉内固定治疗老年股骨转子间骨折的疗效相当; 但与传统导向器定位动力髋螺钉固定术相比,体外导向器定位动力髋螺钉固定术和微型导向器定位动力髋螺钉固定术的切口小、手术时间短、术中失血少、住院时间短、患者痛苦小,但术中X线透视次数较多。
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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备注/Memo

备注/Memo:
基金项目:浙江省温州市科技局科技项目(Y20110020) 通讯作者:温宏 E-mail:wenhong@wzhealth.com
更新日期/Last Update: 1900-01-01