| 改良扩孔器逆向扩孔DHS内固定术在老年股骨粗隆间骨折的应用 |
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Received:March 03, 2011
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李敬 |
LI Jing |
温州医学院第一附属医院骨科，浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China |
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| 陈巨坤 |
CHEN Ju-kun |
温州医学院第一附属医院骨科，浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China |
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| 周凯 |
ZHOU Kai |
温州医学院第一附属医院骨科，浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China |
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| 沈斌 |
SHEN Bin |
温州市第八人民医院骨科 |
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| 倪向明 |
NI Xiang-ming |
温州市第八人民医院骨科 |
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| 陈雷 |
CHEN Lei |
温州医学院第一附属医院骨科，浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China |
lijing0577@163.com |
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| 期刊信息：《中国骨伤》2011年24卷，第5期，第362-365页 |
| DOI：10.3969/j.issn.1003-0034.2011.05.002 |
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目的：探讨改良扩孔器结合DHS(MDHS术)治疗老年粗隆间骨折的疗效及手术特点。
方法：回顾分析2007年8月至2008年12月收治的老年股骨粗隆间骨折54例，MDHS组与常规DHS组各27例，MDHS组男12例，女15例，年龄69～93岁，平均79.4岁，根据改良Evans分型：Ⅰ型3 例，Ⅱ型12例，Ⅲ型8例，Ⅳ型4 例；DHS组中男10例，女17例，年龄66～88岁，平均77.2岁，Ⅰ型4 例，Ⅱ型14例，Ⅲ型6例，Ⅳ型3 例。对两组的骨折临床愈合时间、术后下地时间、主钉松动率及髋关节功能Harris评分等进行比较。
结果：54例均获得随访，时间21～36个月，平均27.6个月，骨折全部愈合。两组骨折临床愈合时间比较，差异无统计学意义(P>0.05).术后下地时间，MDHS组(14.2±2.1) d较DHS组(18.9±3.1) d明显提前 (P<0.05);主钉松动发生情况，MDHS组(1例)明显少于DHS组(8例) (P<0.05).髋关节功能Harris总评分，MDHS组(87.8±4.7)分明显高于DHS组(83.3±7.5)分(P<0.05).
结论：MDHS具有主钉把持力强，手术适应证广，下地活动时间早，术后并发症少等特点，在治疗骨质疏松性粗隆间骨折中疗效明显优于传统的DHS. |
| [关键词]:股骨骨折 髋骨折 骨折固定术，内 外科手术 老年人 临床对照试验 |
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| Application of dynamic hip screw with modified reamer in intertrochanteric fracture in the elderly |
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Abstract:
Objective: To investigate the therapeutic effect and characteristic of dynamic hip screw with modified reamer(MDHS for short) in the treatment of the intertrochanteric fracture in the elderly.
Methods: Fifty-four patients with intertrochanteric fracture from Aug. 2007 to Dec. 2008 were retrospectively analyzed. Among them,27 patients were treated with MDHS,including 12 males and 15 females with an average age of 79.4 years old ranging from 69 to 93 years;according to modified Evans classification,there were 3 cases of typeⅠ，12 cases of typeⅡ，8 cases of typeⅢ，4 cases of typeⅣ。 The other 27 patients(10 males and 17 females),aged from 66 to 88 years old(average 77.2),were composed of 4 cases of typeⅠ，14 cases of typeⅡ，6 cases of typeⅢ，3 cases of typeⅣ。 The fracture healing time,forepart movement time,percentage of loosening screw and hip joint function were compared between two groups.
Results: All 54 patients were followed up for 21 to 36 months (means 27.6 months). All fractures were bone healing. The time of fracture healing were compared between two groups,there were no significant difference(P>0.05). The forepart movement time of MDHS group (14.2±2.1) was shorter than that of DHS group(18.9±3.1)(P<0.05). The loosening screw of MDHS group (1 case) was less than that of DHS group (8 cases) (P<0.05). The Harris score of hip joint function of MDHS group (87.8±4.7) was higher than that of DHS group (83.3±7.5)(P<0.05).
Conclusion: MDHS has several advantages on wider indications,stronger holding power,early forepart movement time,fewer complications,which is a good choice for osteoporotic intertrochanteric fracture. |
| KEYWORDS:Femoral fractures Hip fractures Fracture fixation,internal Surgical procedures,operative Aged Controlled clinical trials |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李敬,陈巨坤,周凯,沈斌,倪向明,陈雷.改良扩孔器逆向扩孔DHS内固定术在老年股骨粗隆间骨折的应用[J].中国骨伤,2011,24(5):362~365 |
| 英文格式: | LI Jing,CHEN Ju-kun,ZHOU Kai,SHEN Bin,NI Xiang-ming,CHEN Lei.Application of dynamic hip screw with modified reamer in intertrochanteric fracture in the elderly[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(5):362~365 |
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