Different Internal Fixation for Intertrochanteric Fractures in Elderly Patients_West China Medical Journal

Authors：

YANG Ling , LONG Cheng , XU Wei ,  LIU Yuehong , WANG Hong , LEI Da

Department of Orthopedics, Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding author：

LIU Yuehong, Email: meggie_f@sina.com

Keywords：

高龄患者; 股骨粗隆间骨折; 内固定; 手术方法

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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。

Citation： YANG Ling,LONG Cheng,XU Wei,LIU Yuehong,WANG Hong,LEI Da. Different Internal Fixation for Intertrochanteric Fractures in Elderly Patients. West China Medical Journal, 2012, 27(12): 1844-1847. doi: Copy

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.	张长青. 关于老年股骨转子间骨折的当代观点[J]. 中华骨科杂志, 2012, 32(7): 611-613.
7.	张英泽, 王庆贤, 潘进社, 等. 微创动力髋螺钉(DHS)治疗老年股骨转子间骨折[J].中华创伤骨科杂志, 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,陈周兵,徐富生.股骨近端锁定钢板治疗股骨转子间骨折[J].中国修复重建外科杂志, 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, 姜为民, 王璐, 等. 4种内固定方式治疗股骨转子间骨折的疗效对比[J].临床骨科杂志, 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.	陈滨, 王钢, 黎润光. 经皮加压钢板微创内固定治疗股骨转子间骨折的初步体会并文献复习[J].中华创伤骨科杂志, 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. 　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. 　张长青. 关于老年股骨转子间骨折的当代观点[J]. 中华骨科杂志, 2012, 32(7): 611-613.
7. 　张英泽, 王庆贤, 潘进社, 等. 微创动力髋螺钉(DHS)治疗老年股骨转子间骨折[J].中华创伤骨科杂志, 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,陈周兵,徐富生.股骨近端锁定钢板治疗股骨转子间骨折[J].中国修复重建外科杂志, 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, 姜为民, 王璐, 等. 4种内固定方式治疗股骨转子间骨折的疗效对比[J].临床骨科杂志, 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. 　陈滨, 王钢, 黎润光. 经皮加压钢板微创内固定治疗股骨转子间骨折的初步体会并文献复习[J].中华创伤骨科杂志, 2009, 11(3): 233-235.
16. 　Gotfried Y. Percutaneous compression plating for intertrochanteric hip fractures: treatment rationale[J]. Orthopedics, 2002, 25(6): 647-652.

West China Medical Journal

Different Internal Fixation for Intertrochanteric Fractures in Elderly Patients

Abstract Full text Figures/Tables Video References Cited by

Format

Content