• 南昌大學(xué)第一附屬醫(yī)院骨科（南昌，330006）;

目的 比較老年股骨粗隆間骨折行改良髖前外側(cè)入路與常規(guī)髖外側(cè)入路的療效。 方法回顧性分析2008年2月－2010年2月收治的61例老年股骨粗隆間骨折患者臨床資料，其中34例采用經(jīng)改良髖關(guān)節(jié)前外側(cè)弧形切口加動(dòng)力髖螺釘（dynamic hip screw，DHS）固定（改良組），27例采用常規(guī)髖外側(cè)切口加DHS固定（常規(guī)組）。兩組患者性別、年齡、致傷原因、Evans分型、合并癥、受傷至入院時(shí)間、髖關(guān)節(jié)Harris評(píng)分等一般資料比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。 結(jié)果兩組患者均順利完成手術(shù)。改良組手術(shù)時(shí)間、術(shù)中出血量、術(shù)中透視次數(shù)、引流量、住院時(shí)間及負(fù)重天數(shù)均顯著少于常規(guī)組，差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。兩組患者均獲隨訪，隨訪時(shí)間12～24個(gè)月，平均 18.7個(gè)月。患者骨折均獲骨性愈合，改良組和常規(guī)組骨折愈合時(shí)間分別為（11.64 ± 1.28）周和（12.29 ± 1.12）周，比較差異無(wú)統(tǒng)計(jì)學(xué)意義（t=2.15，P=0.15）。術(shù)后3、6、12個(gè)月兩組Harris評(píng)分均顯著優(yōu)于術(shù)前（P  lt; 0.05），術(shù)后各時(shí)間點(diǎn)間比較差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）；改良組術(shù)后各時(shí)間點(diǎn)Harris評(píng)分均優(yōu)于常規(guī)組（P  lt; 0.05）。兩組切口感染、肢體短縮、髖內(nèi)翻畸形愈合、主釘切出股骨頭、內(nèi)固定松動(dòng)發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），但改良組總并發(fā)癥發(fā)生率優(yōu)于常規(guī)組，差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。 結(jié)論采用改良髖前外側(cè)入路手術(shù)治療老年股骨粗隆間骨折，能達(dá)到充分暴露，并能減少肌肉損傷，降低手術(shù)風(fēng)險(xiǎn)，配合術(shù)后早期功能鍛煉能盡快恢復(fù)髖關(guān)節(jié)功能。

引用本文： 戴閩,鄒帆,張斌,聶濤,程明,鄒飏,江川. 改良髖前外側(cè)入路與髖外側(cè)入路治療老年股骨粗隆間骨折療效比較. 中國(guó)修復(fù)重建外科雜志, 2012, 26(8): 910-914. doi: 復(fù)制

1. Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures. Int Orthop, 2003, 27(1): 11-17.
2. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg (Br), 1949, 31B(2): 190-203.
3. Harris WH. Hraumatic of the hip after dislocation and arthroplasty. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
4. 戴閩. 骨科治療與康復(fù). 北京: 人民衛(wèi)生出版社, 2007: 206-210.
5. Moran CG, Wenn RT, Sikand M, et al. Early mortality after hip fracture: is delay before surgery important. J Bone Joint Surg (Am), 2005, 87(3): 483-489.
6. A. H. 克倫肖. 坎貝爾骨科手術(shù)大全. 上海: 上海翻譯出版公司, 1991: 846-849.
7. Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hi p screw for treatment of unstable intertrochanteric hip fractures: a biomchanical evaluation. Injury, 2006, 37(10): 984-989.
8. Ho M, Garau G, Walley G, et al. Minimally invasive dynamic hip screw for fixation of hip fractures. Int Orthop, 2009, 33(2): 555-560.
9. Setiobudi T, Ng YH, Lim CT, et al. Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw. Ann Acad Med Singapore, 2011, 40(11): 482-487.
10. 李敬, 陳巨坤, 周凱, 等. 改良擴(kuò)孔器逆向擴(kuò)孔DHS內(nèi)固定術(shù)在老年股骨粗隆間骨折的應(yīng)用. 中國(guó)骨傷, 2011, 24(5): 362-265.
11. 袁勤, 李前龍, 黃劍. DHS內(nèi)固定治療股骨粗隆間骨折致髖內(nèi)翻的防治. 中國(guó)實(shí)用醫(yī)藥, 2009, 4(35): 54-55.
12. 鄒帆, 戴閩. 早期運(yùn)動(dòng)康復(fù)對(duì)下肢骨折治療的臨床意義. 中國(guó)矯形外科雜志, 2011, 19(24): 2065-2068.
13. Harris B, Owen JR, Wayne JS, et al. Does femoral component loosening poredispose to femoral fracture?: an in vitro comparison of cemented hips. Clin Orthop Relat Res, 2010, 468(2): 497-503.
14. Kijowski R, Gold GE. Routine 3D magnetic resonance imaging of joints. J Magn Reson Imaging, 2011, 33(4): 758-771.
15. 戴閩, 聶濤, 李明軍, 等. 改良股骨外側(cè)入路治療股骨轉(zhuǎn)子間骨折134例. 中華創(chuàng)傷雜志, 2010, 26(7): 612-614.
16. Meneghini RM, Smits SA. Early discharge and recovery with three minimally invasive total hip arthroplasty approaches: a preliminary study. Clin Orthop Relat Res, 2009, 467(6): 1431-1437.
17. Granger CV, Reistetter TA, Graham JE, et al. The uniform data system for medical rehabilitation: report of patients with hip fracture discharhed from comprehensive medical programs in 2000-2007. Am J Phs Med Rehabil, 2011, 90(3): 177-189.
  1. 1. Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures. Int Orthop, 2003, 27(1): 11-17.
  2. 2. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg (Br), 1949, 31B(2): 190-203.
  3. 3. Harris WH. Hraumatic of the hip after dislocation and arthroplasty. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
  4. 4. 戴閩. 骨科治療與康復(fù). 北京: 人民衛(wèi)生出版社, 2007: 206-210.
  5. 5. Moran CG, Wenn RT, Sikand M, et al. Early mortality after hip fracture: is delay before surgery important. J Bone Joint Surg (Am), 2005, 87(3): 483-489.
  6. 6. A. H. 克倫肖. 坎貝爾骨科手術(shù)大全. 上海: 上海翻譯出版公司, 1991: 846-849.
  7. 7. Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hi p screw for treatment of unstable intertrochanteric hip fractures: a biomchanical evaluation. Injury, 2006, 37(10): 984-989.
  8. 8. Ho M, Garau G, Walley G, et al. Minimally invasive dynamic hip screw for fixation of hip fractures. Int Orthop, 2009, 33(2): 555-560.
  9. 9. Setiobudi T, Ng YH, Lim CT, et al. Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw. Ann Acad Med Singapore, 2011, 40(11): 482-487.
  10. 10. 李敬, 陳巨坤, 周凱, 等. 改良擴(kuò)孔器逆向擴(kuò)孔DHS內(nèi)固定術(shù)在老年股骨粗隆間骨折的應(yīng)用. 中國(guó)骨傷, 2011, 24(5): 362-265.
  11. 11. 袁勤, 李前龍, 黃劍. DHS內(nèi)固定治療股骨粗隆間骨折致髖內(nèi)翻的防治. 中國(guó)實(shí)用醫(yī)藥, 2009, 4(35): 54-55.
  12. 12. 鄒帆, 戴閩. 早期運(yùn)動(dòng)康復(fù)對(duì)下肢骨折治療的臨床意義. 中國(guó)矯形外科雜志, 2011, 19(24): 2065-2068.
  13. 13. Harris B, Owen JR, Wayne JS, et al. Does femoral component loosening poredispose to femoral fracture?: an in vitro comparison of cemented hips. Clin Orthop Relat Res, 2010, 468(2): 497-503.
  14. 14. Kijowski R, Gold GE. Routine 3D magnetic resonance imaging of joints. J Magn Reson Imaging, 2011, 33(4): 758-771.
  15. 15. 戴閩, 聶濤, 李明軍, 等. 改良股骨外側(cè)入路治療股骨轉(zhuǎn)子間骨折134例. 中華創(chuàng)傷雜志, 2010, 26(7): 612-614.
  16. 16. Meneghini RM, Smits SA. Early discharge and recovery with three minimally invasive total hip arthroplasty approaches: a preliminary study. Clin Orthop Relat Res, 2009, 467(6): 1431-1437.
  17. 17. Granger CV, Reistetter TA, Graham JE, et al. The uniform data system for medical rehabilitation: report of patients with hip fracture discharhed from comprehensive medical programs in 2000-2007. Am J Phs Med Rehabil, 2011, 90(3): 177-189.