摘要
目的:探讨改良扩孔器结合DHS(MDHS术)治疗老年粗隆间骨折的疗效及手术特点。方法:回顾分析2007年8月至2008年12月收治的老年股骨粗隆间骨折54例,MDHS组与常规DHS组各27例,MDHS组男12例,女15例,年龄69～93岁,平均79.4岁,根据改良Evans分型:Ⅰ型3例,Ⅱ型12例,Ⅲ型8例,Ⅳ型4例;DHS组中男10例,女17例,年龄66～88岁,平均77.2岁,Ⅰ型4例,Ⅱ型14例,Ⅲ型6例,Ⅳ型3例。对两组的骨折临床愈合时间、术后下地时间、主钉松动率及髋关节功能Harris评分等进行比较。结果:54例均获得随访,时间21～36个月,平均27.6个月,骨折全部愈合。两组骨折临床愈合时间比较,差异无统计学意义(P>0.05)。术后下地时间,MDHS组(14.2±2.1)d较DHS组(18.9±3.1)d明显提前(P<0.05);主钉松动发生情况,MDHS组(1例)明显少于DHS组(8例)(P<0.05)。髋关节功能Harris总评分,MDHS组(87.8±4.7)分明显高于DHS组(83.3±7.5)分(P<0.05)。结论:MDHS具有主钉把持力强,手术适应证广,下地活动时间早,术后并发症少等特点,在治疗骨质疏松性粗隆间骨折中疗效明显优于传统的DHS。
Objective：To investigate the therapeutic effect and characteristic of dynamic hip screw with modified reamer （MDHS for short） in the treatment of the intertrochanteric fracture in the elderly. Methods：Fifty-four patients with intertmchanteric fracture from Aug. 2007 to Dec. 2008 were retrospectively analyzed. Among them, 27 patients were treated with MDHS,including 12 males and 15 females with an average age of 79.4 years old ranging from 69 to 93 years;according to modified Evans classification, there were 3 cases of type I , 12 cases of type II , 8 cases of type III, 4 cases of type IV. The other 27 patients （10 males and 17 females）, aged from 66 to 88 years old （average 77.2）,were composed of 4 cases of type I , 14 cases of type II , 6 cases of type III, 3 cases of type IV. The fracture healing time, forepart movement time, percentage of loosening screw and hip joint function were compared between two groups. Results：All 54 patients were followed up for 21 to 36 months （means 27.6 months）. All fractures were bone healing. The time of fracture healing were compared between two groups, there were no significant difference （P〉0.05）. The forepart movement time of MDHS group （14.2±2.1） was shorter than that of DHS group （ 18.9±3.1 ） （P〈0.05）. The loosening screw of MDHS group （ 1 case） was less than that of DHS group （8 cases ） （P〈0.05）. The Harris score of hip joint function of MDHS group （87.8±4.7） was higher than that of DHS group （83.3±7.5） （P〈0.05）. Conclusion：MDHS has several advantages on wider indications, stronger holding power,early forepart movement time, fewer complications, which is a good choice for osteoporotic intertrochanteric fracture.
出处
《中国骨伤》
CAS
2011年第5期362-365,共4页
China Journal of Orthopaedics and Traumatology
关键词
股骨骨折
髋骨折
骨折固定术
内
外科手术
老年人
临床对照试验
Femoral fractures
Hip fractures
Fracture fixation,internal
Surgical procedures,operative
Aged
Controlled clinical trials
