贵州医科大学学报

2018, v.43;No.213(06) 734-737+744

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两种手术方法治疗股骨转子间骨质疏松性骨折的疗效
Clinical Comparison of Two Kinds of Surgical Methods in Treatment of Intertrochanteric Osteoporotic Fractures

蔡韵律;
CAI Yunlv;The Eighth People's Hospital of Shanghai;

摘要(Abstract):

目的:探讨动力髋螺钉(DHS)与亚洲型股骨近端防旋髓内钉(PFNAⅡ)术式治疗股骨转子间骨质疏松性骨折的治疗效果。方法:根据手术方式将220例股骨转子间骨质疏松性骨折患者均分为DHS组和PFNAⅡ组,记录2组患者手术时间、术中出血量、切口长度和术后卧床时间、住院时间及骨折愈合时间;术后随访半年,采用Harris评分评价2组患者关节功能恢复优良率,采用自制满意度调查问卷评价骨折复位满意度,观察治疗及随访期间的并发症。结果:DSH组手术时间、术中出血量及术后卧床时间均显著高于PFNAⅡ组,切口长度、骨折愈合时间显著低于PFNAⅡ组,差异有统计学意义(P<0.05);DSH组Harris评分优良率及Ⅲ、Ⅳ型骨折复位满意度均显著低于PFNAⅡ组,差异有统计学意义(P<0.05);DSH组并发症发生率显著高于PFNAⅡ组,差异有统计学意义(P<0.05)。结论:DHS和PFNAⅡ两种手术均能用于股骨转子间骨质疏松性骨折治疗,但PFNAⅡ术式更适于重度骨折。
Objective: To explore the clinical effects of the two surgical methods: dynamic hip screw( DHS) and Asian proximal femoral nail anti-rotation( PFNA II) in the treatment of intertrochanteric osteoporotic fractures. Methods: The clinical data of 210 patients with intertrochanteric osteoporotic fractures treated in our hospital were retrospectively analyzed. And the patients were divided into the DHS group and the PFNA II group according to surgical methods. The conditions during hospital stay of the two groups were recorded,and the patients were followed up for six months. The patients' recovery rate of joint function was compared by hip joint Harris score one year after operation with that before operation,and the complications during the treatment and follow-up were recorded. Results: The operative time,intraoperative blood loss and postoperative bedridden time were significantly higher in the DHS group than those in the PFNA II group while the incision length and the fracture healing time were significantly lower than those in PFNA II group( P < 0. 05),and there was no significant difference during hospital stay in the two groups( P > 0. 05). The excellent and good rate of Harris scores was 85. 5% in the DHS group,which was significantly lower than that in the PFNA II group with93. 6%( P < 0. 05). The satisfactory reduction of Type I and II fracture was 100% in the DHS group,which was not significantly different from that in the PFNA II group with 88. 5%( P > 0. 05). And the satisfactory reduction of Type III and IV fracture was 71. 4% in the DHS group,which was significantly lower than that in the PFNA II group with 90. 5%( P < 0. 05). The incidence rate of complications was 46. 4% in the DHS group,which was significantly higher than that in the PFNA II group with7. 3%( P < 0. 05). Conclusions: Both DHS and PFNA II can be used for the treatment of intertrochanteric osteoporotic fractures. And the latter one is more suitable for severe fractures,especially unstable fractures,with fewer complications.

关键词(KeyWords): 动力髋螺钉;PFNA Ⅱ术;骨质疏松;股骨转子间骨折;疗效;关节功能;并发症
dynamic hip screw;PFNA Ⅱ;osteoporosis;intertrochanteric fracture;curative effects;joint function;complications

Abstract:

Keywords:

基金项目(Foundation): 上海市卫生厅科研项目(2013WS20663)

作者(Author): 蔡韵律;
CAI Yunlv;The Eighth People's Hospital of Shanghai;

Email:

DOI: 10.19367/j.cnki.1000-2707.2018.06.025

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