[1]李坛珠,张保焜,莫小联,等.极高龄不稳定股骨粗隆间骨折的髓内和髓外固定疗效比较[J].中华老年骨科与康复电子杂志,2017,(01):17-21.[doi:10.3877/cma.j.issn.2096-0263.2017.01.004]
　Li Tanzhu,Zhang Baokun,Mo Xiaolian,et al.The comparative analysis of extramedullary to intramedullary fixations for unstable femur intertrochanteric fractures in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(01):17-21.[doi:10.3877/cma.j.issn.2096-0263.2017.01.004]
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极高龄不稳定股骨粗隆间骨折的髓内和髓外固定疗效比较()
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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:
2017年01期
页码:
17-21
栏目:
股骨骨折
出版日期:
2017-02-05

文章信息/Info

Title:
The comparative analysis of extramedullary to intramedullary fixations for unstable femur intertrochanteric fractures in elderly patients
作者:
李坛珠 2; 张保焜 1; 莫小联 2; 冯祥 2; 高悠水 1; 殷吉旻 1; 沙茹拉 1; 丁坚 1; 张伟 1
200233 上海交通大学附属第六人民医院骨科 1；857000 西藏日喀则市人民医院骨科 2
Author(s):
Li Tanzhu;  Zhang Baokun;  Mo Xiaolian;  Feng Xiang;  Gao Youshui;  Yin Jimin;  Sha Rula;  Ding Jian;  Zhang Wei
1Department of Orthopedics, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 200233, China; 2Department of Orthopedics, Rikaze People’s Hospital, Tibet 857000, China
关键词:
髋;  骨折;  骨折固定术; 髓内;  髓外;  老年人
Keywords:
Hip fractures;  Fracture fixation;  intramedullary;  Extramedullary;  Aged
DOI:
10.3877/cma.j.issn.2096-0263.2017.01.004
文献标志码:
A
摘要:
目的 分析比较髓内固定和髓外固定治疗极高龄不稳定股骨粗隆间骨折的疗效。方法回顾性分析 2012年 10月至 2013年 10月上海交通大学附属第六人民医院收治的 85 岁以上单侧不稳定股骨粗隆间骨折患者 60 例，根据固定方式分为髓内组（n=30）和髓外组（n=30）。随访并比较两组患者手术时长、X线透视次数、总失血量、显性失血量、隐性失血量、总输血量、伤口愈合不良与感染、术后院内并发症发生情况与住院死亡率、术后 1年内院外死亡率、骨折内固定失败、坐起和负重时间、骨折愈合时间和髋关节功能（Harris评分）。结果 髓内组和髓外组的手术时间、透视次数、术中显性出血量、院外 1年内死亡率、开始坐轮椅时间、骨折愈合时间和髋关节Harris评分比较，差异均无统计学意义。髓内组总出血量（[ 470±29）ml]、隐性出血量（[ 395±9）ml]和总输血量（[ 350±28）ml]均显著高于髓外组（[ 234±34）ml、（147±36）ml、（175±9）ml]，差异具有统计学意义（t=4.365，t=7.655，t=6.395，P＜0.05）；髓外组开始负重时间为（61±6）d，晚于髓内组（[ 10.4±1.7）d]，差异具有统计学意义（t=9.698，P＜0.05）。髓内组脏器并发症发生率以及内固定失败率都高于髓外组（P＜0.05），但院外一年内死亡率无显著差异。结论 髓内固定治疗活动能力较好以及骨质疏松较轻的患者，生物力学优势明显，但对于极高龄股骨粗隆间患者，髓外固定可取得较好的疗效，安全性较高。
Abstract:
Objective To compare the effect of extra-medullary fixation and intramedullary fixation for the femoral intertrochanteric fractures of the elderly. Methods A retrospective analysis was performed in 60 patients with unilateral femoral intertrochanteric fracture in Shanghai Sixth People’s Hospital from October 2012 to October 2013. They were divided into extramdullary (Locking plate) and intramedullary groups (Intertan nail) with 30 patients in each group. Operation time, times of X rays, total blood loss, obvious blood loss, hidden blood loss, incidence of poor healing and surgical infection, complications and death, fixation failure, time of bed- to- chair and weight- bearing, bone healing time and Harris scores were followed and compared between two groups. Results There were no significant differences in operation time, times of Xray, obvious blood loss, death within one year, time of bed- to- chair, bone healing time and Harris scores between two groups (P>0.05); the hidden blood loss, total blood loss, incidence of major complications, fixation failure and blood infusion in intramedullary group was higher than that in extramedullary group, with statistical significance (P<0.05). Time to weight- bearing in extramedullary group [(61.5 ± 5.95) d] was longer than that in intramedullary group [(10.4±1.7) d]. Conclusion Extra-medullary fixations were more effective and safe in treating serious femoral intertrochanteric fractures of the oldest, while patients with better motion abilities and less osteoporosis underwent intramedullary fixations presented better biomechanics benefits.

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备注/Memo

备注/Memo:
基金项目：上海交通大学多中心临床研究项目（DLY201616）
更新日期/Last Update: 2017-04-01