| 不同手术方法治疗高龄股骨粗隆间骨折的病例对照研究 |
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Received:January 20, 2017
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| 作者 | Author | 单位 | Unit | E-Mail |
| 朱立军 |
ZHU Li-jun |
涟水县中医院骨科, 江苏 涟水 223400 |
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| 李晓飞 |
LI Xiao-fei |
青岛大学附属医院关节外科, 山东 青岛 266000 |
Department of Joint Surgery, the Affiliated Hospital of Qiingdao University, Qingdao 266000, Shandong, China |
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| 刘超 |
LIU Chao |
青岛大学附属医院关节外科, 山东 青岛 266000 |
Department of Joint Surgery, the Affiliated Hospital of Qiingdao University, Qingdao 266000, Shandong, China |
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| 吕成昱 |
LYU Cheng-yu |
青岛大学附属医院关节外科, 山东 青岛 266000 |
Department of Joint Surgery, the Affiliated Hospital of Qiingdao University, Qingdao 266000, Shandong, China |
lxfbisheng@126.com |
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| 期刊信息：《中国骨伤》2017年30卷，第7期，第607-611页 |
| DOI：10.3969/j.issn.1003-0034.2017.07.005 |
| 基金项目:国家自然科学基金资助项目（81601875） |
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目的：分析股骨近端锁定接骨板（LPFP）、股骨近端防旋髓内钉（PFNA）及双极人工股骨头置换（BPH）治疗高龄老年人股骨粗隆间骨折的临床效果。
方法：回顾性分析2011年6月至2016年8月采用LPFP、PFNA内固定及BPH治疗的75岁以上高龄股骨粗隆间骨折86例患者临床资料，LPFP组男10例，女16例；年龄（72.54±4.78）岁；EvansⅡ型5例，Ⅲ型12例，Ⅳ型9例。PFNA组男17例，女22例；年龄（74.41±5.65）岁；EvansⅡ型11例，Ⅲ型18例，Ⅳ型10例。BPH组男9例，女12例；年龄（76.23±6.97）岁；EvansⅡ型1例，Ⅲ型10例，Ⅳ型10例。病程2~3个月。比较3组手术时间、术中出血量、住院时间、术后并发症发生率和髋关节功能Harris评分。
结果：术后患者伤口愈合良好，无并发症发生。84例获得随访，2例失访（随访率为97.6%）。随访时间22~41个月，平均26.3个月。手术时间及住院时间比较中，BPH组比LPFP组和PFNA组明显缩短（F=19.782，21.981；P<0.05）；术中出血量的比较中，BPH组比PFNA组和LPFP组明显减少（F=12.976，P<0.05）；PFNA组与LPFP组比较差异无统计学意义（t=10.879，P>0.05）。术后并发症发生率的比较中，LPFP组较PFNA组和BPH组高（F=30.976，P<0.05）；PFNA组与BPH组比较差异无统计学意义（χ2=9.902，P>0.05）。术后1年髋关节功能Harris评分的比较中，PFNA组和BPH组均优于LPFP组（F=19.692，P<0.05），而PFNA组与BPH组比较差异无统计学意义（t=4.971，P>0.05）。
结论：对于全身情况较差的高龄患者（>75岁），BPH手术时间短，术后并发症少，是最优的选择。对于单纯的股骨粗隆间骨折患者，PFNA也具有明显的优势，术者可根据情况选择。对于高龄的股骨粗隆间骨折患者，不建议应用LPFP。 |
| [关键词]:老年人 股骨骨折 骨折固定术,内 关节成形术,置换,髋 |
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| Clinical analysis of LPFP,PFNA and BPH in treating femoral intertrochanteric fractures in elderly patients |
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Abstract:
Objective: To evaluate the clinical results of locking proximal femur plate(LPFP),proximal femoral nail antirotation(PFNA) and bipolar hemiarthroplasty(BPH) in the treatment of femoral intertrochanteric fractures in elderly patients.
Methods: Retrospective analysis of the 86 elderly patients with femoral intertrochanteric fractures during June 2011 and August 2016 were enrolled in this study. The patients were divided into 3 groups:26 cases in LPFP group included 10 males and 16 females with an average age of (72.54±4.78) years old,5 cases of type Ⅱ of Evans,12 cases of type Ⅲ and 9 cases of type Ⅳ;39 cases in PFNA group included 17 males and 22 females with an average age of 74.41±5.65,11 cases of type Ⅱ,18 cases of type Ⅲ and 10 cases of type Ⅳ;21 cases in BPH group included 9 males and 12 females with an average age of 76.23±6.97,1 case of type Ⅱ,10 cases of type Ⅲ and 10 cases of type Ⅳ. The data of three groups were collected for statistical analysis on the following aspects:operation time,intraoperative blood loss,the length of hospital stay,postoperative complications and Harris score of the hip joint function.
Results: The wound healed well and no complication occurred. Eighty-four cases were follow-up,while 2 cases were lost,the follow-up rate was 97.6%. The patients were followed up for 22 to 41 months with an average of 26.3 months. For comparison of operation time and time of the hospital stay,BPH group was shorter than the LPFP and PFNA group(F=19.782,21.981,P<0.05). For comparison of the intraoperative blood loss,the BPH group was less blood loss than the LPFP and PFNA group(F=12.976,P<0.05),while there was no significant means between the LPFP and PFNA group(t=10.879,P>0.05). For comparison of the postoperative complications,LPFP group was higher than BHP and PFNA group(F=30.976,P<0.05),while there was no significant means between LPFP and PFNA group(t=9.902,P>0.05). For comparison of the Harris score of the hip joint at 1 year after operation,BPH and PFNA group were both higher than LPFP group(F=19.692,P<0.05),while there was no significant means between BPH and PFNA group (t=4.971,P>0.05).
Conclusion: For elder patient with femoral intertrochanteric fracture,BPH could be the best optional for the shorter operation time and less complications. And the PFNA also could be optional choice for the patients while the LPFP was forbidden for the elder patients. |
| KEYWORDS:Elderly Femoral fractures Fracture fixation,internal Arthroplasty,replacement,hip |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 朱立军,李晓飞,刘超,吕成昱.不同手术方法治疗高龄股骨粗隆间骨折的病例对照研究[J].中国骨伤,2017,30(7):607~611 |
| 英文格式: | ZHU Li-jun,LI Xiao-fei,LIU Chao,LYU Cheng-yu.Clinical analysis of LPFP,PFNA and BPH in treating femoral intertrochanteric fractures in elderly patients[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(7):607~611 |
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