目的 回顾分析不同内固定方式对老年股骨粗隆间骨折的临床疗效。 方法 1999年3月－2009年5月采用内固定手术治疗121例股骨粗隆间骨折患者，根据内固定方式不同分为4组：动力髋螺钉（DHS；A组43例）、经皮加压钢板（PCCP；B组19例）、股骨近端髓内钉（PFN；C组27例）、Gamma钉（D组32例）。4组患者年龄、骨折类型（Tronzo-Evans分型）等一般资料比较差异无统计学意义（P＞0.05），具有可比性。记录手术时间、术中出血量及术后引流量、术中术后并发症、骨折临床愈合时间、术后髋关节功能恢复程度，比较评价各组临床疗效。 结果 术后各组患者切口均Ⅰ期愈合，无伤口感染等早期并发症发生。患者均获随访，随访时间18～108个月，平均56.4个月。与A组比较，B、C、D组手术时间明显缩短，术中出血量及术后引流量减少，骨折愈合时间缩短，差异均有统计学意义（P＜0.01），A组较差；B、C、D各组间两两比较差异无统计学意义（P＞0.05）。术后并发症发生率A组较高，与其余各组比较差异有统计学意义（P＜0.05）。末次随访时各组髋关节功能Harris评分比较差异无统计学意义（P＞0.05）。 结论 B、D组及C组3种手术方法在治疗老年患者股骨粗隆间骨折具有创伤小、并发症少等优势，与A组法比较更有利于老年患者术后康复，但应注意骨折的良好复位及内固定物位置。
目的:观察高龄不稳定型粗隆间骨折人工关节置换术的治疗效果。方法:2005年1月至2008年1月收治高龄不稳定型股骨粗隆间骨折患者56例,行人工关节置换术治疗,按照Harris标准评分分析效果。结果:56例患者均顺利完成手术,平均手术时间62 min,平均住院17天。随访1～3年,术后14月因突发脑出血死亡1例,其余患者功能恢复良好。按照Harris标准评分优良率为91%。结论:高龄股骨粗隆间骨折采用人工关节置换术治疗安全有效。
目的:探讨股骨近端解剖型钢板治疗股骨粗隆间骨折的临床疗效。方法:自2005年1月至2009年1月,采用切开复位,股骨近端解剖型钢板治疗股骨粗隆间骨折46 例。结果: 术后随访6个月～3年,平均18个月,所有病例均在术后3～55个月获得骨性愈合,髋关节功能根据Harris评分标准进行评定,优32 例,良4 例。结论: 股骨近端解剖型钢板适用于治疗大多数类型的股骨粗隆间骨折,能达到良好的骨折复位和坚强的固定,促进关节早期功能锻炼,骨折愈合率高,是治疗股骨粗隆间骨折的理想选择。
Objective To study the effectiveness of anterolateral C-shaped approach in the treatment of intertrochanteric fracture of the femur in elderly patient by comparing with traditional anterolateral approach. Methods Between April 2010 and November 2011, 66 patients with intertrochanteric fracture of the femur were analyzed retrospectively. Of 66 patients, 37 underwent improved anterolateral C-shaped approach combined with fixation of dynamic hip screw (DHS) (improved group), and 29 underwent traditional anterolateral approach combined with fixation of DHS (conventional group). There was no significant difference in gender, age, injury cause, side, disease duration, fracture type, and complication between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, postoperative drainage volume, and hospitalization time were recorded; and X-ray films were taken to observe the fracture healing. The hip function was evaluated according to self-established criterion. Results The operation was successfully completed in all patients, and primary healing of incision was achieved. All patients were followed up 12-24 months (mean, 17.8 months). Bone union was achieved in both groups; the fracture healing time was 3-6 months (mean, 4.8 months). No loosening or breaking of internal fixation was observed during follow-up period. The operation time and postoperative drainage volume of improved group were significantly less than those of conventional group (P lt; 0.05); no significant difference was found in intraoperative blood loss and hospitalization days between 2 groups (P gt; 0.05). According to self-established criterion, improved group was significantly better than conventional group in recovery of hip joint motion and function at 6 and 12 months after operation (P lt; 0.05). Conclusion Anterolateral C-shaped approach combined with DHS could minimize muscle injury and scar formation, which is beneficial to surgical exposure and early postoperative rehabilitation.
Objective To investigate the influence of the integration of fracture treatment and exercise rehabilitation on the effectiveness in the patients with intertrochanteric fracture of femur. Methods Between January 2007 and December 2009, 3 873 patients with intertrochanteric fracture of femur were surgically treated in 56 hospitals. Of them, 1 970 cases were treated with rehabilitation training according to scale of safety assessment of early exercise rehabilitation of patients with fractures (trial group), 1 903 cases were treated with traditional rehabilitation training methods (control group). There was no significant difference in age, gender, fracture type, internal fixation type, or postoperative safety score between 2 groups (P gt; 0.05). Results All the patients were followed up 13-49 months (mean, 30.5 months). There was no significant difference in the incidences of bone nonunion, delayed union, and systemic complication between 2 groups (P gt; 0.05); significant differences were found in the incidences of incision complication, deep vein thrombosis of the lower extremity, and the overall complication between 2 groups (P lt; 0.05). At 6 and 12 months after operation, the trial group was significantly better than the control group in the recovery of hip motion, curative effectiveness classification, and the excellent and good rate (P lt; 0.05). Conclusion The treatment of intertrochanteric fracture of the femur guided by the integration of fracture treatment and exercise rehabilitation can apparently improve the prognosis and reduce the incidence of complications.
Objective To compare the effectiveness of the proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in the treatment of elderly patients with intertrochanteric fractures. Methods Between May 2007 and May 2010, 63 elderly patients with intertrochanteric fractures were treated, and fractures were fixed with PFNA in 31 patients (PFNA group) and with DHS in 32 patients (DHS group). There was no significant difference in gender, age, injury cause, disease duration, and fracture type between 2 groups (P gt; 0.05). Results All incisions healed by first intention. The incision length, operation time, and blood loss in PFNA group were significantly less than those in DHS group (P lt; 0.05). The averagefollow-up time was 13.6 months in PFNA group and was 13.8 months in DHS group. The fracture heal ing time was (11.80 ± 1.32) weeks in PFNA group and was (12.21 ± 1.26) weeks in DHS group, showing no significant difference (t=1.23, P=0.29). The complication rate was 0 in PFNA group and was 12.5% (4/32) in DHS group, showing no significant difference (P=0.06). After 1 year, Harris hip score of PFNA group (86.55 ± 10.32) was higher than that of DHS group (80.36 ±11.18) (t=2.28, P=0.03). Conclusion There are two surgical methods to treat intertrochanteric fractures in the elderly patient: PFNA and DHS, and each has advantages; for unstable intertrochanteric fractures, PFNA treatment is the first choice.
Objective To compare the effectiveness between improved anterolateral approach and lateral approach in the treatment of senile intertrochanteric fracture. Methods The clinical data were retrospectively analyzed, from 61 patients with senile intertrochanteric fracture treated between February 2008 and February 2010. Of 61 patients, 34 patients underwent improved anterolateral approach combined with fixation of dynamic hip screw (improved group), and 27 patients underwent conventional lateral approach combined with fixation of dynamic hip screw (conventional group). There was no significant difference in gender, age, injury cause, Evans classification, comorbidities, disease duration, or Harris hip scores between 2 groups (P gt; 0.05). Results The operation was successfully completed in all patients. The operation time, blood loss, perspective frequency during operation, drainage volume, hospitalization days, and out-of-bed time in the improved group were significantly less than those in the conventional group (P lt; 0.05). All patients were followed up 12-24 months (mean, 18.7 months). Bone union was achieved in both groups; the fracture healing time was (11.64 ± 1.28) weeks in the improved group and was (12.29 ± 1.12) weeks in the conventional group, showing no significant difference (t=2.15, P=0.15). Harris hip scores at 3, 6, and 12 months were significantly better than preoperative scores in 2 groups (P lt; 0.05), and significant differences were found among different time points after operation in 2 groups (P lt; 0.05), between 2 groups after operation (P lt; 0.05). There was no significant difference in the incidence of incision infection, limb shortening, coax vara, internal fixation loosening, main screw cutting-out from femoral head between 2 groups (P gt; 0.05), but the incidence of total complications in the improved group was significantly lower than that in the conventional group (P lt; 0.05). Conclusion Compared with conventional lateral approach, improved anterolateral approach has the advantages of sufficient exposure, reducing muscle damage and surgical risk in treating intertrochanteric fracture. Operating treatment of improved anterolateral approach combined with early rehabilitation after surgery can recover hip joint function as quickly as possible.
Objective To investigate the appl ication of anti-rotation screw after dynamic hi p screw (DHS) in treatment of intertrochanteric fracture. Methods Between April 2006 and January 2010, 22 cases of intertrochanteric fractures underwent DHS fixation operation with an anti-rotation screw, including 15 males and 7 females with an average ageof 66.3 years (range, 54-83 years). Fractures were caused by sl ipping in 16 cases, traffic accident in 5 cases, and fall ing from height in 1 case. All cases showed closed fractures, including 13 cases in the left and 9 cases in the right. Eighteen cases were simple intertrochanteric fracture, 4 cases were intertrochanteric fractures compl icated with Colles fractures. According to Evans classification standard, there were 14 cases of type I, 6 cases of type II, 1 case of type III, and 1 case of type IV. The time from wound to operation was 3-7 days (mean, 4.5 days). Results The operation time ranged from 51-95 minutes (mean, 72 minutes). The intraoperative blood loss was 150-350 mL (mean, 270 mL). The hospital ization days were 12-35 days (mean, 16.8 days). Primary heal ing was observed in all cases. All cases were followed up 6-17 months (mean, 14 months). Union of fracture was observed at 12-16 weeks (mean, 13.6 weeks); no fracture or internal fixation loosening occurred. According to HUANG Gongyi’s standard of efficacy assessment, the results were excellent in 19 cases and good in 3 cases. Conclusion Appl ication of an anti-rotation screw can help to improve the strength of the DHS for the internal fixation of intertrochanteric fracture, especially the anti-rotation abil ity, which does not increase the operation time obviously.