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摘要:目的:对比动力髋螺钉(DHS)与股骨近端解剖锁定板(PFLP)内固定治疗高龄股骨粗隆间骨折(IFF)疗效。方法:将我院收治的149例高龄IFF患者依据手术方式差异分组,其中75例给予PFLP内固定设为PFLP组,其余74例给予DHS内固定设为DHS组,对比两组疗效。结果:PFLP组手术所用时间(81.1±6.9)min与失血量(254.3±47.9)ml均明显不及DHS组的(86.8±12.5)min、(286.1±34.7)ml高(P<0.05)。两组术前功能评分差异不大(P>0.05);PFLP组术后90天、180天、360天评分分别为70.6±6.8、81.5±7.3、83.5±8.6,明显高于DHS组的44.9±7.0、52.7±6.3、61.5±6.9,术后不同时间点PFLP组功能评分明显更理想(P<0.05)。结论:采用闭合复位经皮PFLP内固定治疗高龄IFF患者,操作简便且疗效确切,深具临床采纳价值。
关键词:闭合复位;股骨近端解剖锁定板;股骨粗隆间骨折
【Abstract】Objective:To compare the dynamic hip screw (DHS) and proximal femur anatomic locking plate internal fixation (PFLP) for senile intertrochanteric fractures (IFF) curative effect. Methods: 149 cases of elderly patients with IFF difference group according to the operation way, among them 75 cases as PFLP PFLP internal fixation group, the remaining 74 cases for DHS internal fixation for DHS group, compared two groups of curative effect. Results: PFLP group used time (81.1±6.9) min and blood loss (254.3±47.9 ml) were significantly less than DHS group (86.8±12.5) min and (286.1 34.7 mm) high ml (P < 0.05). Two groups of preoperative functional score difference (P > 0.05); PFLP group after 90 days, 180 days, 360 days score were 70.6, 81.5 ± 7.3, 7.3 6.8 mm ± 8.6, significantly higher than DHS group was 44.9 ± 7.0, 7.0, 61.5 6.9 mm, 6.3 mm different time points after functional score PFLP group was obviously better (P < 0.05). Conclusion: the closed reduction and percutaneous PFLP internal fixation in the treatment of elderly patients with IFF, easy operation and curative effect, has adopted clinical value.
【Key words】Closed reduction; Proximal femur anatomic locking plate; Intertrochanteric fractures
【中图分类号】R4 【文献标识码】A 【文章编号】1672-8602(2015)01-0153-01
IFF是老年人易發的骨折疾病,约占老年患者的28%[1]。该类骨折在年龄超过70岁的老人中较多发,骨折后若未能得到及时有效治疗,将严重影响患者身心健康,甚至危及其生命。传统保守治疗并发症较多,当前临床普遍采用手术内固定治疗。我院本次对收治的149例高龄IFF患者分别给予了DHS与PFLP内固定治疗,现报告如下。
1 资料与方法
1.1 一般资料 将我院收治的149例高龄IFF患者依据手术方式差异分组,其中75例给予PFLP内固定设为PFLP组,其余74例给予DHS内固定设为DHS组。两组男女性例数分别为89、60例,年龄范围在69~81岁,(73.2±2.1)岁为年龄平均数。依据Evans对骨折分型:Ⅰ、Ⅱ、Ⅲ、Ⅳ型分别为38、31、56、24例,发生骨折到施行手术时间在3~7天内。两组上述差异无统计学意义(P>0.05),具有可比性。
1.2 手术方法
1.2.1 PFLP组:选择持续硬膜外麻醉或全身麻醉[2]。患者取仰卧姿势并轻微内收内旋位,将患侧臀部垫至平卧位高度,在C臂机与X线机透视下给予骨折牵引复位,复位理想后行常规消毒铺巾并将患肢固定在牵引床上。若牵引复位不理想,则切开重新复位并注意对患处骨膜组织尽量不剥离。在股骨大粗隆下2.0厘米左右外侧切长2.0~4.0厘米的口子,切开皮肤、皮下、髂胫束,并钝性将肌层分开与分离到股骨大粗隆部,注意避免剥离骨膜。依据所需钢板长度借助骨膜剥离器于骨膜外行股外侧肌与骨膜间的皮下隧道,钢板上安装定位导向器并尽量贴近骨面而置入皮下隧道,确保其处于骨膜外并紧贴股骨干和处于股骨干正中。借助导向器将4颗导针打入到患者的股骨头颈中,并经透视确定其深度后再将适宜锁定螺钉拧入。若骨折缝隙较大可先采用松质骨拉力螺钉复位再将锁定螺钉拧入。骨折远端借助导向器拧入3~4枚皮质骨锁定螺钉。清洗切口置入引流管后关闭切口。
关键词:闭合复位;股骨近端解剖锁定板;股骨粗隆间骨折
【Abstract】Objective:To compare the dynamic hip screw (DHS) and proximal femur anatomic locking plate internal fixation (PFLP) for senile intertrochanteric fractures (IFF) curative effect. Methods: 149 cases of elderly patients with IFF difference group according to the operation way, among them 75 cases as PFLP PFLP internal fixation group, the remaining 74 cases for DHS internal fixation for DHS group, compared two groups of curative effect. Results: PFLP group used time (81.1±6.9) min and blood loss (254.3±47.9 ml) were significantly less than DHS group (86.8±12.5) min and (286.1 34.7 mm) high ml (P < 0.05). Two groups of preoperative functional score difference (P > 0.05); PFLP group after 90 days, 180 days, 360 days score were 70.6, 81.5 ± 7.3, 7.3 6.8 mm ± 8.6, significantly higher than DHS group was 44.9 ± 7.0, 7.0, 61.5 6.9 mm, 6.3 mm different time points after functional score PFLP group was obviously better (P < 0.05). Conclusion: the closed reduction and percutaneous PFLP internal fixation in the treatment of elderly patients with IFF, easy operation and curative effect, has adopted clinical value.
【Key words】Closed reduction; Proximal femur anatomic locking plate; Intertrochanteric fractures
【中图分类号】R4 【文献标识码】A 【文章编号】1672-8602(2015)01-0153-01
IFF是老年人易發的骨折疾病,约占老年患者的28%[1]。该类骨折在年龄超过70岁的老人中较多发,骨折后若未能得到及时有效治疗,将严重影响患者身心健康,甚至危及其生命。传统保守治疗并发症较多,当前临床普遍采用手术内固定治疗。我院本次对收治的149例高龄IFF患者分别给予了DHS与PFLP内固定治疗,现报告如下。
1 资料与方法
1.1 一般资料 将我院收治的149例高龄IFF患者依据手术方式差异分组,其中75例给予PFLP内固定设为PFLP组,其余74例给予DHS内固定设为DHS组。两组男女性例数分别为89、60例,年龄范围在69~81岁,(73.2±2.1)岁为年龄平均数。依据Evans对骨折分型:Ⅰ、Ⅱ、Ⅲ、Ⅳ型分别为38、31、56、24例,发生骨折到施行手术时间在3~7天内。两组上述差异无统计学意义(P>0.05),具有可比性。
1.2 手术方法
1.2.1 PFLP组:选择持续硬膜外麻醉或全身麻醉[2]。患者取仰卧姿势并轻微内收内旋位,将患侧臀部垫至平卧位高度,在C臂机与X线机透视下给予骨折牵引复位,复位理想后行常规消毒铺巾并将患肢固定在牵引床上。若牵引复位不理想,则切开重新复位并注意对患处骨膜组织尽量不剥离。在股骨大粗隆下2.0厘米左右外侧切长2.0~4.0厘米的口子,切开皮肤、皮下、髂胫束,并钝性将肌层分开与分离到股骨大粗隆部,注意避免剥离骨膜。依据所需钢板长度借助骨膜剥离器于骨膜外行股外侧肌与骨膜间的皮下隧道,钢板上安装定位导向器并尽量贴近骨面而置入皮下隧道,确保其处于骨膜外并紧贴股骨干和处于股骨干正中。借助导向器将4颗导针打入到患者的股骨头颈中,并经透视确定其深度后再将适宜锁定螺钉拧入。若骨折缝隙较大可先采用松质骨拉力螺钉复位再将锁定螺钉拧入。骨折远端借助导向器拧入3~4枚皮质骨锁定螺钉。清洗切口置入引流管后关闭切口。