股骨近端防旋髓內釘和動力髖螺釘治療高齡股骨粗隆間骨折的優劣差異

王偉東

【摘要】 目的：探討高齡股骨粗隆間骨折患者使用股骨近端防旋髓內釘和動力髖螺釘治療的效果。方法：選取2016年1-12月在本院接受治療的高齡股骨粗隆間骨折患者100例，其中采用動力髖螺釘治療的患者50例作為對照組，采用動力髖螺釘治療的患者50例作為研究組。比較兩組手術一般情況、臨床治療效果及術后并發癥情況。結果：研究組術中出血量顯著少于對照組（P<0.05），手術時間、骨性愈合時間、負重時間及住院時間均顯著短于對照組（P<0.05）。研究組優良率為72.00%顯著優于對照組的56.00%（P<0.05），且研究組術后髖關節Harris評分顯著高于對照組（P<0.05）。研究組術后并發癥發生率為4.00%顯著低于對照組的20.00%（P<0.05）。結論：在高齡股骨粗隆間骨折患者治療中選擇股骨近端防旋髓內釘可有效提高治療效果，術中損傷較小，術后恢復快，且安全性高，值得臨床推廣使用。

【關鍵詞】 動力髖螺釘； 股骨近端防旋髓內釘； 股骨粗隆間骨折

【Abstract】 Objective：To investigate the effect of proximal femoral nail and dynamic hip screw in the treatment of elderly patients with femoral intertrochanteric fracture.Method：100 cases of elderly patients with femoral intertrochanteric fracture from January 2016 to December 2016 in our hospital were selected，50 cases treated with dynamic hip screw patients as the control group，50 cases treated with dynamic hip screw as the study group.The general surgery situation，clinical treatment and postoperative complications of two groups were compared.Result：The amount of intraoperative bleeding of the study group was significantly less than that of the control group（P<0.05），the operation time，bone healing time，weight-bearing time and hospital stay of the study group were significantly shorter than those of the control group（P<0.05）.The excellent and good rate of the study group was 72.00%，and the control group was 56.00%，the excellent and good rate of the study group was significantly better than that of the control group（P<0.05），the postoperative Harris hip score of the study group was significantly higher than that of the control group（P<0.05）.The incidence of postoperative complications of the study group was 4.00%，and the control group was 20.00%，the incidence of postoperative complications of the study group was significantly lower than that of the control group（P<0.05）.Conclusion：The elderly patients with femoral intertrochanteric fracture in the treatment of choice of proximal femoral nail anti rotation can effectively improve the treatment effect，less damage to the patients，rapid postoperative recovery，and high safety，it is worthy of promotion in clinical use.

【Key words】 Dynamic hip screw； Proximal femoral nail； Femoral intertrochanteric fracture

First-authors address：Panyu Hospital of Chinese Medicine，Guangzhou 511400，China

doi：10.3969/j.issn.1674-4985.2017.29.013

股骨粗隆間骨折是臨床中常見的一種老年人骨折之一，是指發生于股骨頸基底至小粗隆水平以上的骨折[1]。致病原因主要是因為骨質疏松和外傷，另外與地區、性別、種族等也有關系[2]。股骨粗隆間骨折多發于伴有骨質疏松的高齡患者，隨著近年來老齡化和平均壽命的延長，股骨粗隆間骨折發病率逐年上升。研究報道，美國每年股骨粗隆間骨折大約發生25萬例[3]，骨折后常伴有股骨矩和粗隆后部損傷，治療不當容易引起患者出現髖內翻畸形[4]。因此需要給予患者早期安全有效治療，目前多數人主張在股骨粗隆間骨折治療時，如果患者身體情況允許，盡量采用內固定技術來治療以獲得穩定復位，盡量恢復患者關節功能，降低術后并發癥發生率，改善患者預后[5]。近年來，治療老年粗隆間骨折的常用手術方式為動力髖螺釘和股骨近端防旋髓內釘[6]。為探討兩種術式的治療效果，對本院高齡股骨粗隆間骨折患者使用股骨近端防旋髓內釘和動力髖螺釘治療情況進行分析，現報道如下。……