• 德陽(yáng)市人民醫(yī)院骨科（四川德陽(yáng)，618000）;

目的 　回顧分析不同內(nèi)固定方式對(duì)老年股骨粗隆間骨折的臨床療效。 方法 　1999年3月－2009年5月采用內(nèi)固定手術(shù)治療121例股骨粗隆間骨折患者，根據(jù)內(nèi)固定方式不同分為4組：動(dòng)力髖螺釘（DHS；A組43例）、經(jīng)皮加壓鋼板（PCCP；B組19例）、股骨近端髓內(nèi)釘（PFN；C組27例）、Gamma釘（D組32例）。4組患者年齡、骨折類型（Tronzo-Evans分型）等一般資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05），具有可比性。記錄手術(shù)時(shí)間、術(shù)中出血量及術(shù)后引流量、術(shù)中術(shù)后并發(fā)癥、骨折臨床愈合時(shí)間、術(shù)后髖關(guān)節(jié)功能恢復(fù)程度，比較評(píng)價(jià)各組臨床療效。 結(jié)果 　術(shù)后各組患者切口均Ⅰ期愈合，無(wú)傷口感染等早期并發(fā)癥發(fā)生?；颊呔@隨訪，隨訪時(shí)間18～108個(gè)月，平均56.4個(gè)月。與A組比較，B、C、D組手術(shù)時(shí)間明顯縮短，術(shù)中出血量及術(shù)后引流量減少，骨折愈合時(shí)間縮短，差異均有統(tǒng)計(jì)學(xué)意義（P＜0.01），A組較差；B、C、D各組間兩兩比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。術(shù)后并發(fā)癥發(fā)生率A組較高，與其余各組比較差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。末次隨訪時(shí)各組髖關(guān)節(jié)功能Harris評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。 結(jié)論 　B、D組及C組3種手術(shù)方法在治療老年患者股骨粗隆間骨折具有創(chuàng)傷小、并發(fā)癥少等優(yōu)勢(shì)，與A組法比較更有利于老年患者術(shù)后康復(fù)，但應(yīng)注意骨折的良好復(fù)位及內(nèi)固定物位置。

引用本文： 楊靈,龍成,徐巍,劉躍洪,汪紅,雷達(dá). 老年患者股骨粗隆間骨折內(nèi)固定治療. 華西醫(yī)學(xué), 2012, 27(12): 1844-1847. doi: 復(fù)制

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1. 　Liporace FA，Egol KA, Tejwani N, et al. What’s new in hip fractures? Current concepts[J]. Am J Orthop (Belle Mead NJ), 2005, 34(2): 66-74.
2. 　Jesen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis[J]. Acta Orthop Scand, 1975, 46(5): 795-803.
3. 　Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg (Am), 1969, 51(4): 737-755．.
4. 　Doruk H, Mas MR, Yildiz C, et al. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly[J]. Arch Gerontol Geriatr, 2004, 39(2): 179-185．.
5. 　Zuckerman JD, Skovron ML, Koval KJ, et al. Postoperative complications and mortality associated with operative delay in older patients who have fracture of the hip[J]. J Bone Joint Surg (Am), 1995, 77(10): 1551-1556.
6. 　張長(zhǎng)青. 關(guān)于老年股骨轉(zhuǎn)子間骨折的當(dāng)代觀點(diǎn)[J]. 中華骨科雜志, 2012, 32(7): 611-613.
7. 　張英澤, 王慶賢, 潘進(jìn)社, 等. 微創(chuàng)動(dòng)力髖螺釘(DHS)治療老年股骨轉(zhuǎn)子間骨折[J].中華創(chuàng)傷骨科雜志, 2005, 7 (4) : 318-321.
8. 　Alobaid A, Harvey EJ, Elder GM, et al. Minimally invasive dynamic hip screw: prospective randomized trial of two techniques of insertion of a standard dynamic fixation device[J]. J Orthop Trauma, 2004, 18(4): 207-212.
9. 　李必奎,陳周兵,徐富生.股骨近端鎖定鋼板治療股骨轉(zhuǎn)子間骨折[J].中國(guó)修復(fù)重建外科雜志, 2011, 25(10): 1273-1275.
10. 　Ramakrishnan M, Prasad SS, Parkinson RW, et al. Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail.Injury[J]. 2004, 35(2): 184-190.
11. 　李雪峰, 姜為民, 王璐, 等. 4種內(nèi)固定方式治療股骨轉(zhuǎn)子間骨折的療效對(duì)比[J].臨床骨科雜志, 2009, 12(3): 302-304.
12. 　Werner-Tutschku W, Lajtai G, Schmiedhuber G, et al. Intra-and perioperative complications in the stabilization of per-and subtrochanteric femoral fractures by means of PFN[J]．Unfallchirurg, 2002, 105(10): 881-885．.
13. 　Banan H, Al-sabti A, Jimulia T, et al. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN) our first 60 cases [J]. Injury, 2002, 33(5): 401-405.
14. 　Kosygan KP, Mohan R, Newman RJ. The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip[J]. J Bone Joint Surg (Br), 2002, 84(1):19-22.
15. 　陳濱, 王鋼, 黎潤(rùn)光. 經(jīng)皮加壓鋼板微創(chuàng)內(nèi)固定治療股骨轉(zhuǎn)子間骨折的初步體會(huì)并文獻(xiàn)復(fù)習(xí)[J].中華創(chuàng)傷骨科雜志, 2009, 11(3): 233-235.
16. 　Gotfried Y. Percutaneous compression plating for intertrochanteric hip fractures: treatment rationale[J]. Orthopedics, 2002, 25(6): 647-652.
  1. 1. 　Liporace FA，Egol KA, Tejwani N, et al. What’s new in hip fractures? Current concepts[J]. Am J Orthop (Belle Mead NJ), 2005, 34(2): 66-74.
  2. 2. 　Jesen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis[J]. Acta Orthop Scand, 1975, 46(5): 795-803.
  3. 3. 　Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg (Am), 1969, 51(4): 737-755．.
  4. 4. 　Doruk H, Mas MR, Yildiz C, et al. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly[J]. Arch Gerontol Geriatr, 2004, 39(2): 179-185．.
  5. 5. 　Zuckerman JD, Skovron ML, Koval KJ, et al. Postoperative complications and mortality associated with operative delay in older patients who have fracture of the hip[J]. J Bone Joint Surg (Am), 1995, 77(10): 1551-1556.
  6. 6. 　張長(zhǎng)青. 關(guān)于老年股骨轉(zhuǎn)子間骨折的當(dāng)代觀點(diǎn)[J]. 中華骨科雜志, 2012, 32(7): 611-613.
  7. 7. 　張英澤, 王慶賢, 潘進(jìn)社, 等. 微創(chuàng)動(dòng)力髖螺釘(DHS)治療老年股骨轉(zhuǎn)子間骨折[J].中華創(chuàng)傷骨科雜志, 2005, 7 (4) : 318-321.
  8. 8. 　Alobaid A, Harvey EJ, Elder GM, et al. Minimally invasive dynamic hip screw: prospective randomized trial of two techniques of insertion of a standard dynamic fixation device[J]. J Orthop Trauma, 2004, 18(4): 207-212.
  9. 9. 　李必奎,陳周兵,徐富生.股骨近端鎖定鋼板治療股骨轉(zhuǎn)子間骨折[J].中國(guó)修復(fù)重建外科雜志, 2011, 25(10): 1273-1275.
  10. 10. 　Ramakrishnan M, Prasad SS, Parkinson RW, et al. Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail.Injury[J]. 2004, 35(2): 184-190.
  11. 11. 　李雪峰, 姜為民, 王璐, 等. 4種內(nèi)固定方式治療股骨轉(zhuǎn)子間骨折的療效對(duì)比[J].臨床骨科雜志, 2009, 12(3): 302-304.
  12. 12. 　Werner-Tutschku W, Lajtai G, Schmiedhuber G, et al. Intra-and perioperative complications in the stabilization of per-and subtrochanteric femoral fractures by means of PFN[J]．Unfallchirurg, 2002, 105(10): 881-885．.
  13. 13. 　Banan H, Al-sabti A, Jimulia T, et al. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN) our first 60 cases [J]. Injury, 2002, 33(5): 401-405.
  14. 14. 　Kosygan KP, Mohan R, Newman RJ. The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip[J]. J Bone Joint Surg (Br), 2002, 84(1):19-22.
  15. 15. 　陳濱, 王鋼, 黎潤(rùn)光. 經(jīng)皮加壓鋼板微創(chuàng)內(nèi)固定治療股骨轉(zhuǎn)子間骨折的初步體會(huì)并文獻(xiàn)復(fù)習(xí)[J].中華創(chuàng)傷骨科雜志, 2009, 11(3): 233-235.
  16. 16. 　Gotfried Y. Percutaneous compression plating for intertrochanteric hip fractures: treatment rationale[J]. Orthopedics, 2002, 25(6): 647-652.