股骨近端锁定钢板治疗老年股骨转子间骨折34例临床分析

[摘要] 目的 探讨股骨近端锁定钢板在老年股骨转子间骨折治疗中的应用价值。方法 将68例老年股骨转子间骨折患者随机分为观察组和对照组各34例，观察组采用股骨近端锁定钢板内固定术，对照组采用动力髋螺钉内固定术治疗，比较两组的临床效果。 结果 观察组优良率为85.29%，对照组优良率为61.76%，两组优良率比较差异有统计学意义（P < 0.05）。观察组的各项手术观察指标均明显优于对照组，两组比较差异有高度统计学意义（P < 0.01）。 结论 股骨近端锁定钢板内固定具有创伤小、固定牢靠、术后并发症少等优点，值得临床推广。

[关键词] 股骨转子间骨折；老年；股骨近端锁定钢板；动力髋螺钉

[中图分类号] R683.42 [文献标识码] A [文章编号] 1674-4721（2012）07（b）-0041-02

Clinical analysis of proximal femoral locking plate for treatment of intertrochanteric fracture of femur in the elderly in 34 cases

TUO Dengjun

Depatment of Orthopaedics, the Third People's Hospital of Li County of Changde City in Hunan Province, Li County 415500, China

[Abstract] Objective To investigate the application value of proximal femoral locking plate for intertrochanteric fracture of femur in the elderly. Methods Sixty eight cases of elderly patients with intertrochanteric fracture of femur were randomly divided into the observation group and the control group with 34 cases in each, the observation group was treated with proximal femoral locking plate internal fixation, the control group was treated with dynamic hip screw fixation, clinical effect of two groups were compared. Results In the observation group, the excellent and good rate was 85.29%, compared with that of the control group (61.76%), the excellent and good rate of two groups had significant difference (P < 0.05). The operation indexes of observation group were significantly better than those in the control group, there was significant difference (P < 0.01). Conclusion Proximal femoral locking plate internal fixation with less trauma, reliable fixation, fewer postoperative complications, is worthy of clinical application.

[Key words] Femoral intertrochanteric fracture; Elderly; Locking proximal femoral plate; Dynamic hip screw

股骨转子间骨折是中老年人的常见髋部骨折，占其10％～34％，全身骨折的3％～4％[1]。2007年1月～2011年12月，本院采用股骨近端锁定钢板内固定术治疗老年股骨转子间骨折患者34例，效果满意，现总结报道如下：

1 资料与方法

1.1 一般资料

本组共68例，男36例，女性32例，年龄61～85岁，平均74岁；致伤原因：车祸21例，摔倒40例，坠落伤7例，均为闭合性骨折。骨折按Evans分型[2]：I型28例，Ⅱ型13例，ⅢA型12例，ⅢB型9例，Ⅳ型6例；合并有高血压者18例，冠心病6例，糖尿病14例。将患者随机分为观察组和对照组各34例，两组患者的各项临床基本资料经统计学处理，差异无统计学意义（P > 0.05），具有可比性。

1.2 手术方法

手术均在连续硬膜外麻醉或全身麻醉下进行，取仰卧位，患髋垫高30°。观察组采用股骨近端锁定钢板内固定术：取髋外侧纵行切口，逐层暴露，显露骨折端及股骨大转子，尽可能减少骨膜的剥离，在C臂X线机监控下复位，复位满意后于股骨近端外侧放置长度合适的股骨近端锁定钢板，C形臂X线机透视确定钢板位置合适后，在锁定套筒的引导下先用3枚导针将钢板近端固定于股骨头颈内，再次在C形臂X线机正侧位透视下逐一拔除导针并拧入3枚锁定螺钉，选择长度合适的3～4枚锁定螺钉锁定钢板远端。对照组采用动力髋螺钉（DHS）内固定术治疗：取髋外侧切口显露大转子及股骨上段。牵引复位，在大转子顶点下2 cm处向股骨头颈方向打入1枚导针，在导针上下方2 cm处向股骨头颈方向各平行打入1枚克氏针，C臂X线机透视确定骨折复位良好，导针位置满意后，依次测深、钻孔、旋入螺钉并安装套筒钢板，最后拧入加压尾钉固定钢板。术后所有患者均常规静脉滴注抗生素5～7 d，术后在疼痛可忍受的情况下即可开始被动锻炼，并逐渐加强过渡到主动锻炼；术后8周后根据X线片显示骨折愈合情况，开始部分负重运动。