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目的探讨微创内固定治疗老年骨质疏松不稳定股骨转子间骨折的方法及疗效。方法回顾性分析2009年1月-2015年9月采用Intertan或短重建钉(TAN)内固定微创治疗的112例老年性骨质疏松股骨转子间骨折患者的临床资料。所有患者均结合病史、查体及影像学检查进行诊断,按照AO分型,31-A.1型34例,31-A.2型61例,31-A.3型17例。对手术时间、透视时间、术中失血量、住院天数、并发症及髋关节功能评分等进行统计分析。结果 112例患者中78例获随访,随访时间3~27个月(平均15个月),其中Intertan组41例,TAN组37例。Intertan组手术时间、透视时间(分别为58.9±6.9、2.70±0.47min)明显短于TAN组(分别为75.6±5.9、4.40±0.47min),术中出血量(107.6±6.7ml)明显低于TAN组(127.8±6.8ml),髋关节Harris评分优良率(73%)高于TAN组(65%),术后并发症发生率(4.9%)低于TAN组(10.8%),差异均有统计学意义(P<0.05)。两组住院天数、骨折愈合时间比较差异无统计学意义(P>0.05)。结论Intertan和TAN两种微创固定方法治疗不稳定股骨转子间骨折均可取得较好的临床疗效,其中Intertan具有操作简单、固定可靠、出血少、髋关节功能恢复好、并发症少等优点,是治疗老年骨质疏松不稳定股骨转子间骨折的良好选择。
Objective To investigate the method and efficacy of minimally invasive internal fixation in the treatment of unstable intertrochanteric fractures of the elderly with osteoporosis. Methods The clinical data of 112 elderly patients with intertrochanteric fractures of the intertrochanteric fractures treated with Intertan or short internal fixation by short internal fixation (TAN) from January 2009 to September 2015 were analyzed retrospectively. All patients were diagnosed by histopathology, physical examination and imaging examination. According to AO classification, 34 cases were 31-A.1, 61 cases were 31-A.2 and 17 cases were 31-A.3. The operation time, fluoroscopy time, intraoperative blood loss, hospitalization days, complications and hip function score were statistically analyzed. Results Of the 112 patients, 78 were followed up for 3-27 months (mean 15 months), 41 in Intertan group and 37 in TAN group. The Intertan group had shorter operative time and fluoroscopy time (58.9 ± 6.9,2.70 ± 0.47min, respectively) than those in the TAN group (75.6 ± 5.9 and 4.40 ± 0.47min, respectively). The intraoperative bleeding volume (107.6 ± 6.7ml) TAN group (127.8 ± 6.8ml) and hip joint Harris score (73%) were higher than TAN group (65%). The incidence of postoperative complications (4.9%) was lower than that of TAN group (10.8%) Statistical significance (P <0.05). There was no significant difference between the two groups in hospitalization days, fracture healing time (P> 0.05). Conclusion Intertan and TAN two minimally invasive fixation methods can achieve better clinical efficacy in the treatment of unstable femoral intertrochanteric fractures. Intertan has the advantages of simple operation, reliable fixation, less bleeding, better hip joint function recovery, fewer complications, Is the treatment of unstable osteoporosis femoral intertrochanteric fractures of a good choice.