摘要
目的:观察不同类型股骨转子间骨质疏松性骨折患者应用小切口动力髋螺钉及Gamma钉内固定植入技术对髋关节功能的改善作用。方法:选择2004-07/2006-07上海市杨浦区中心医院骨科收治的高龄(65岁以上)股骨转子间骨折患者33例。根据改良Evens分型为Ⅰ～Ⅴ型,其中稳定型Ⅰ～Ⅱ型18例,不稳定型Ⅲ～Ⅴ型15例。所有稳定型18例采用动力髋螺钉固定,其余15例不稳定型采用Gamma钉内固定术。术后早期行髋关节间隙主动及被动锻炼。观察手术切口大小,操作时间,术中出血量,并发症情况。髋关节功能评价采用Harris髋关节功能评分方法(满分为100分,90分以上为优,80分以上为较好,70分以上为良,低于70分为差)。结果:33例均得到随访,平均随访8个月。①小切口动力髋螺钉组:切口长度为4cm(3～5cm),平均手术时间70min(60～100min),术中平均出血量100mL(50～200mL);微创Gamma钉组:切口长度3cm(2.5～4.5cm),平均手术时间50min(40～70min),术中平均出血量65mL(30～100mL)。②术后髋关节功能评定:优30例(90.9%),良3例(9.1%)。③术后1,3,6,8个月随访复查髋关节X线片,三四个月全部骨折愈合,双下肢基本等长,无髋内翻畸形。④2例行动力髋螺钉内固定术的切口出现小块皮肤坏死,1例Gamma钉内固定患者,术后4个月发现拉力螺钉自股骨头上方切出,复片示骨折愈合,行内固定取出。结论:小切口动力髋螺钉及Gamma钉内固定植入技术治疗股骨转子间骨折创伤小,术后髋关节功能恢复好,适用于老年患者。
AIM： To observe the curative effects of minimally invasive dynamic hip screw （DHS） and Gamma nail fixation on various intertrochantedc osteoporotic fractures in the elderly. METHODS：From July 2004 to July 2006, 33 cases of femoral intertrochantedc fracture over 65 years old were selected from the Department of Orthopaedics, Yangpu Central Hospital. According to improved Evens classification （type I to V ）, there were 18 cases of stable type （type I to Ⅱ ）, and 15 of unstable type （type Ⅲ to V ）. Eighteen cases of stable type were operated with DHS through minimal incision, while 15 cases of unstable type with Gamma nail. Passive and initiative activities were conducted intermittently in an early period. Length of incision, operation time, blood loss, and complications were analyzed, and hip joint function were assessed by Harris hip score, in which the total scores were 100, and excellent scored by 90 or more, very good by 80 or more, good by 70 or more, and bad by 70 or less. RESULTS： Thirty-three cases were all followed up for average 8 months. ①ln the DHS through minimal incision group, the mean length of incision was 4 cm （3 to 5 cm）, mean time of operation was 70 minutes （60 to 100 minutes）, mean blood loss during operation was 100 mL （50 to 200 mL）; In the Gamma group, the mean length of incision was 3 cm （2.5 to 4.5 cm）, mean time of operation was 50 minutes （40 to 70 minutes）, mean blood loss during operation was 65 mL （30 to 100 mL）. ②All patients were evaluated with Harris hip scores： 30 cases （90.9%） were excellent, and 3 （9.1%） were good. ③Union of fracture was observed with X-ray at the 1^st, 3^rd, 6^th and 8^th months after operation. It showed that the fractures were all union after 3 to 4 months. ④Two cases with DHS suffered from cutaneous necrosis, and one case with Gamma nail was found fracture union and femoral head cutting at four month after operation, and then treated with internal fixation to take out. CONCLUSION： DHS and Gamma nail have minimal trauma, and could promote the functional recovery, so they are ideal choices for the treatment of intertrochanteric fractures in the eldedy.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第29期5821-5823,共3页
Journal of Clinical Rehabilitative Tissue Engineering Research
