老年股骨转子间骨折内固定方法比较.docVIP

老年股骨转子间骨折内固定方法比较[摘要]目的 分析比较几种老年股骨转子间骨折的不同内固定治疗方法的优劣。方法 1992～2010年随机选择200例老年股骨转子间骨折，按Tronzo—Evans分类，其中Ⅱ型55例，Ⅲ型58例，Ⅳ型52例，Ⅴ型35例，分别给予不同手术内固定。 结果 半年后随访，能独立行走179例，扶杖行走16例，借助轮椅行走3例，死亡2例。按照X线评定标准患者满意度为95.9%。髋关节功能评定优良率94.4%。经比较，锁定板及PFN内固定优良率最高。 结论 股骨转子间骨折的治疗以锁定板、PFN内固定为佳 。 [关键词] 股骨转子间骨折；内固定；锁定加压板 [中图分类号] R687.3 [文献标识码] B [文章编号] 1673—9701（2012）25—0157—02 Comparison and analysis of different internal fixations on the elderly femoral intertrochanteric fracture LIU Yujie Department of Orthopaedics，the Third Peoples Hospital of Zhengzhou City，Zhengzhou 450000，China [Abstract] Objective To compare and analyze the clinic results of different fixations on the elderly femoral intertrochanteric fracture. Methods From 1992 to 2010， 200 elderly patients with femoral intertrochanteric fractures were chosen randomly. According to Tronzo—Evans classification， 55 cases were of stage Ⅱ；58 of Ⅲ；52 of Ⅳ；35 of Ⅴ.They were treated with different internal fixations. Results All cases were followed up for 6 months and the findings suggested that 179 patients could walk independently while 16 used walking sticks and 3 wheelchairs except 2 deaths. According to X—ray criteria， satisfactory rate accounted for 95.9%. Hip functional restoration pointed that the excellence rate reached 94.4%. The comparison shows that Locking compression plate fixation and PFN excel others. Conclusion Locking compression plate fixation and PFN are better choices for femoral intertrochanteric fractures. [Key words] Femoral intertrochanteric fractures；Internal fixation；Locking compression plate 老年股骨转子间骨折多与骨质疏松有关，平均年龄70岁以上，长期卧床并发症多，病死率高。本文回顾分析了我院治疗的200例老年股骨转子间骨折，比较不同的内固定治疗方法的优劣，现报道如下。 1资料与方法 1.1 一般资料 选择1992～2010年收治的200例股骨转子间骨折，年龄65～84 岁（平均72岁），按Tronzo—Evans分类[1]，Ⅱ型55例，Ⅲ型58例，Ⅳ型52例，Ⅴ型35例。其中斯氏针内固定40例（A组）、加压滑移螺钉DHS内固定40例（B组）、Gamma钉内固定40例（C组）、股骨近端钉PFN内固定40例（D组）、LCP锁定板固定40例（E组），卧床时间2～6周。研究过程中，A组与C组各有1例患者死亡，共有198例患者按方案完成研究。 1.2 治疗方法 均先在C臂X线机透视下利用牵引床闭合复位。A组 使用4枚直径3.5 mm斯氏针，下位2针进针点在粗隆顶点下10～12 cm经过小粗隆内侧股骨距至股