[1]王虎 李明 靳泽岳 连晓东 陈伟. 不同方法治疗老年股骨转子间合并转子下骨折的比较[J].中华老年骨科与康复电子杂志,2019,(03):135-142.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.003]
　Wang Hu,Chen Wei.. Comparative of different methods for the treatment of intertrochanteric-subtrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(03):135-142.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.003]
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 不同方法治疗老年股骨转子间合并转子下骨折的比较()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年03期
页码:
135-142
栏目:
股骨骨折
出版日期:
2019-06-05

文章信息/Info

Title:
 Comparative of different methods for the treatment of intertrochanteric-subtrochanteric fracture
作者:
 王虎1 李明2 靳泽岳2 连晓东2 陈伟2
051450 承德，围场县医院骨科1；050051 石家庄，河北医科大学第三医院创伤急救中心2
Author(s):
  Wang Hu1;  Chen Wei2.
 

1Department of Orthopaedics, Weichang County Hospital, Chengde 051450; 2Department of Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China

关键词:
 ; 老年人;  髋骨折;  骨折固定术; 内
Keywords:
 ; Aged;  Hip fractures;  Fracture fixation;  internal
DOI:
DOI：10.3877/cma.j.issn.2096-0263.2019.003
文献标志码:
A
摘要:
 

【摘要】 目的 比较不同方法治疗老年股骨转子间合并转子下骨折的临床疗效，以期为该类型骨折的临床治疗提供参考。方法 回顾性分析2013年3月至2017年3月在河北医科大学第三医院及围场县医院治疗的51例老年股骨转子间合并转子下骨折的患者资料，其中男性21例（41.2%），女性30例（48.8%）；平均年龄（71±4）岁。分别采用了股骨近端锁定接骨板（PFLP，18例）、重建髓内钉（RIN，16例）及股骨近端防旋髓内钉（PFNA，17例）内固定治疗方法。比较三组患者在性别、年龄、骨折患侧、术前牵引天数、手术时间、手术出血量、全部切口长度、骨折愈合时间、手术并发症、术后髋关节功能评分等方面的差异。结果 51例患者获得满意随访，随访率100%。随访时间12～44个月。PFLP组平均手术时间为（155±27）min、全部切口长度为（20.8±2.6）cm、术中出血量为（274±36）ml、术后引流量为（87±20）ml；RIN组平均手术时间为（122±16）min、所有切口长度为（11.8±1.5）cm、术中出血量为（144±43）ml、隐性失血量为（428±16）ml、出血总量为（558±16）ml；PFNA组平均手术时间为（44.4±4.2）min、所有切口长度为（8.5±0.6）cm、术中出血量为（94±24）ml、隐性失血量为（408±36）ml、出血总量为（520±24）ml。在手术时间、切口长度、术中出血量等方面，PFNA组均低于PFLP组和RIN组，PFLP组的术后引流量明显高于PFNA组和RIN组（P＜0.01）；PFNA组和RIN组的手术总出血量高于PFLP组（P＜0.05）。PFLP组骨折愈合时间为（16.2±2.5）w，高于RIN组[（14.9±1.1）w]和PFNA组[（14.2±1.5）w]，差异有统计学意义（F＝5.224，P＜0.05）。PFLP组的术后第12个月Harris评分[（80±7）分]低于RIN组[（88±4）分]和PFNA组[（91±4）分]，差异有统计学意义（F=19.673，P＜0.01）。结论 本研究中所采用的3种固定方式中，PFNA与PFLP及RIN相比，具有手术切口小、手术时间短、术中出血少、骨折愈合所需时间短、术后髋关节功能恢复好的优点，是治疗老年股骨转子间骨折合并转子下骨折的理想固定方式。

Abstract:

【Abstract】 Objective To compare the clinical efficacy of different methods in the treatment of femoral intertrochanteric-subtrochanteric fractures in the elderly, and provide reference for the clinical treatment of this type of fracture. Methods A retrospective analysis of 51 elderly patients with femoral intertrochanteric and subtrochanteric fractures treated in the Third Hospital of Hebei Medical University and Weichang County Hospital from March 2013 to March 2017, including 21 males (41.2%), females 30 cases (48.8%); age (71±4) years. The proximal femoral locking plate (PFLP), reconstructed intramedullary nail (RIN), and proximal femoral anti-rotation intramedullary nail (PFNA) were used. Differences of gender, age, fracture side, preoperative traction days, operation time, surgical bleeding volume, total incision length, fracture healing time, surgical complications, and postoperative hip function score were compared. Results 51 patients were followed up satisfactorily and the follow-up rate was 100%. The follow-up last for 12 to 44 months. The average operation time of the PFLP group was (155±27) min, the length of all incisions was (20.8±2.6) cm, the intraoperative blood loss was (274±36) ml, and the postoperative drainage volume was (87±20) ml. The average operation time was (122±16) min, the length of all incisions was (11.8±1.5) cm, the intraoperative blood loss was (144±43) ml, the recessive blood loss was (428±16) ml, and the total amount of bleeding was (558±16) ml; the average operation time of the PFNA group was (44.4±4.2) min, the length of all incisions was (8.5±0.6) cm, the intraoperative blood loss was (94±24) ml, and the recessive blood loss was (408±36) ml and the total amount of bleeding is (520±24) ml. In the operative time, length of incision, intraoperative blood loss, PFNA group was lower than PFLP group and RIN group. The postoperative drainage volume of PFLP group was significantly higher than that of PFNA group and RIN group (P<0.01); PFNA group and RIN group The total amount of bleeding in the surgery group was higher than that in the PFLP group (P<0.05). The fracture healing time of PFLP group was (16.2±2.5) w higher than RIN (14.9±1.1) w and PFNA group (14.2±1.5) w, the difference was statistically significant (F=5.224, P<0.05). The Harris score (80±7) in the PFLP group was lower than that in the RIN group (88±4) and the PFNA group (91±4). The difference was statistically significant (F=19.673, P<0.01). ). Conclusions Among the three fixation methods used in this study, PFNA has a smaller surgical incision, shorter operative time, less intraoperative blood loss, shorter time to fracture healing, and better postoperative hip function recovery than PFLP and RIN. The advantage is an ideal fixation method for the treatment of intertrochanteric fractures in the elderly with subtrochanteric fractures.

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备注/Memo

备注/Memo:

基金项目：国家自然科学基金青年科学基金项目（81401789）；首批“河北省青年拔尖人才”项目资助（2013-2015）；河北省优秀青年基金项目（H2017206104）
更新日期/Last Update: 2019-07-09