不同类型内固定治疗老年股骨粗隆间骨折疗效分析
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摘要
目的：分析动力髋螺钉(DHS),动力髁螺钉(DCS),PFN(股骨近端带锁髓内钉)治疗不同类型老年股骨粗隆间骨折的手术疗效。方法：收集近两年我院股骨粗隆间骨折手术病例40例,按内固定不同方式分为DHS组,DCS组,PFN组。DHS组20例,按EVANS分型,Ⅱ型3例,Ⅲ型10例,Ⅳ型7例。DCS组11例,此组均为EVANS V型,即逆粗隆间骨折。PFN组9例,均为粗隆间粉碎骨折。所有病例均获得随访,随访时间为6个月-18个月,分别从手术时间,术中出血量,术中输血量,骨折临床愈合时间,术后关节功能恢复程度,术后并发症等几个方面进行比较,对比分析不同手术方式的治疗结果。结果：本组40例病例,于术后3-6个月拍片复查均达到骨折愈合标准,无髋内翻畸形等术后并发症发生。DHS,DCS在手术时间,术中出血量,术中输血量及术后髋关节功能方面无明显差异。PFN与上述两组比较在手术时间,术中出血量,术中输血量方面比较有明显差异,在术后髋关节功能及骨折愈合时间方面三组无明显差异。结论：DHS, DCS,PFN三种内固定方式在治疗股骨粗隆间骨折有不同的特点,临床治疗应根据骨折类型特点,严格掌握不同类型骨折的手术适应症,选择正确内固定,才能确保手术疗效。DHS适用于股骨顺粗隆间骨折,DCS则对逆粗隆间骨折有较好治疗作用,PFN则适用于粗隆间粉碎骨折。
Objective:To analyze the dynamic hip screw (DHS), dynamic condylar screw (DCS), PFN (proximal femoral nail with the inside) in the treatment of different types of surgical treatment of intertrochanteric fractures. Methods:The collection of the past two years in our hospital cases of intertrochanteric fracture of 40 cases, according to internal fixation in different ways, is divided into DHS group, DCS Group, PFN group. DHS group of 20 cases, according to EVANS typing,Ⅱtype 3 cases,Ⅲin 10 cases,Ⅳtype in 7 cases. DCS treatment of 11 cases in this group were EVANSⅤtype, that is, against the intertrochanteric fracture. PFN group,9 patients were intertrochanteric comminuted fracture.Results:All the patients were followed up for 6 months to 18 months, respectively, from the operative time, blood loss, postoperative complications, postoperative ambulation time, the clinical fracture healing time and degree of postoperative recovery of joint function, postoperative complications, and several other aspects of comparison, the comparative analysis of the results of different surgical methods of treatment. Conclusion: DHS, DCS, PFN three kinds of internal fixation methods in the treatment of intertrochanteric fractures have different characteristics, clinical features should be based on the type of fracture, and strictly control the different types of fractures indication, choosing the right internal fixation, in order to ensure that the surgical treatment of. DHS is for intertrochanteric fractures of the femur Shun, DCS on the reverse intertrochanteric fracture have better therapeutic effect, PFN is especially suitable for intertrochanteric comminuted fracture.
Objective:To analyze the dynamic hip screw (DHS), dynamic condylar screw (DCS), PFN (proximal femoral nail with the inside) in the treatment of different types of surgical treatment of intertrochanteric fractures. Methods:The collection of the past two years in our hospital cases of intertrochanteric fracture of 40 cases, according to internal fixation in different ways, is divided into DHS group, DCS Group, PFN group. DHS group of 20 cases, according to EVANS typing,Ⅱtype 3 cases,Ⅲin 10 cases,Ⅳtype in 7 cases. DCS treatment of 11 cases in this group were EVANSⅤtype, that is, against the intertrochanteric fracture. PFN group,9 patients were intertrochanteric comminuted fracture.Results:All the patients were followed up for 6 months to 18 months, respectively, from the operative time, blood loss, postoperative complications, postoperative ambulation time, the clinical fracture healing time and degree of postoperative recovery of joint function, postoperative complications, and several other aspects of comparison, the comparative analysis of the results of different surgical methods of treatment. Conclusion: DHS, DCS, PFN three kinds of internal fixation methods in the treatment of intertrochanteric fractures have different characteristics, clinical features should be based on the type of fracture, and strictly control the different types of fractures indication, choosing the right internal fixation, in order to ensure that the surgical treatment of. DHS is for intertrochanteric fractures of the femur Shun, DCS on the reverse intertrochanteric fracture have better therapeutic effect, PFN is especially suitable for intertrochanteric comminuted fracture.
引文
[1]Cronell CN.Management of fracture in patients with osteoprosis.The Orthopaedic Clinics of North America,1990,21:125-127
[2]王亦璁.骨与关节损伤, 北京：人民卫生出版社2006：1179
[3]Horwitz BG. Retrospective randomized comparison of the DHS and Gamma locking nail. J Bone Joint Surg.1993:75:789.
[4]Evans.EM.The treatment of peritrochanteric fracture.J Bone Joint Surg(Br),1949,3 1(2):10
[5]戴魁戎主译.现代骨科学.第1版,北京：科学技术文献出版社,2002,389.
[6]王满宣,贾国胜,安贵生等,股骨近端髓内针(PFN)治疗转子部骨折中华创伤骨科杂志,2004(2)6
[7]卢世壁,董天华等.髋关节外科学第1版郑州大学出版社,2005,259
[8]骨少汀.经矩斯氏针内固定治疗粗隆间骨折.中华外科杂志,1992,30：107
[9]王亦璁.骨与关节损伤, 北京：人民卫生出版社2006：1179
[10]毛宾尧.髋关节外科学,北京：人民卫生出版社,1998.216-219
[11]郭世绂,钟世镇等,骨科临床解剖学,山东科学技术出版社.2002 713-714
[12]危杰.股骨转子间骨折.中华创伤骨科杂志,2004,6：554-557,
[13]Harrington KD.The management of comminuted unstbale intertrochanterie fracurte.J Bone Joint Surg (Am),1993,55:1367-1371.
[14]Buamgaertner MR, Curtin SL, LindskogDM.The value of the tip-apex Distance in Predicting failer of fixation of Peritroochanteric fractueres of the hip. J BoneJoint Sugr(B)r1995,77:1058-1064.
[15]王满宜.加强股骨近端骨折的临床研究.中华创伤骨科杂志.2004,5：481-483
[16]Simmermacher RK. Bosch AM. Van der Werken C.AO/ASIF-proximalfemoral nail(PFN):a new device for treatment of unstable proximalfemoral fractures. Injury,1999,30:327-332.
[17]姜丹青,股骨粗隆间骨折的手术治疗中国医师杂志2003(2)5
[18]EllisTj, KyleRf, The results of open reduction interal fixation of a highly Unstbale interrochanteric hip fracture with a dynamic hip screw. Presented as Aposter exhibit at the Annual Meeting of the Ameriean A cademu of Orthopaedic Sugreons;2000,15-19;Orinado, FL.
[19]周雪峰,马华松,等.动力螺钉治疗股骨粗隆部骨折的并发症及其防治[J].中国矫形外科杂志,2004,12(8)：63 1-632
[20]Simmermacher RK. Bosch AM. Van der Werken C.AO/ASIF-proximalfemoral nail(PFN):a new device for treatment of unstable proximal femoral fractures. Injury,1999,30:327-332.
[21]Koval K, J, Zuckerman JD. Intertrochanteric fractures. In:Bu-cholz RW. Heckman JD. eds. Rockwood and Green' S fractures in adults.5th ed Philadelphia Lippincou Williams&Wilkins.2001.1635-1663.
[22]卢世壁,董天华等.髋关节外科学,郑州大学出版社,2005,260
[23]王澍寰临床骨科学上海科学技术出版社,2005,01：616-618
[1]赵炬才,张铁良.髋关节外科学.北京：中国医药出版社,1992.197-221.
[2]Vilhjalmur, FLasrGJ, Gder, T, et al.Hip rfacuture incidence in cenitral norway:a follow up study.Clin Orthop relat Res,2004,1(419):173-178
[3]危杰,股骨转子间骨折,中华创伤骨科杂志,200；46(5)：554-557
[4]胥少汀,葛宝丰,徐印坎.实用骨科学.北京：人民军医出版社,1999.677.
[5]Evana EM.The treatm ent of trocham feric fractures of the femur.Bone Joint surg,1949,31(2):190-194.
[6]许继刚.股骨转子骨折治疗疗效分析(附438例报告).中华骨科杂志,1999,14(2)：150-151.
[7]Richmond J,Aharonoff GB,Zuekeman JD,et al.Mortality risk after hip fracture[J].J Orthop Trauma,2003,17(1):53-56.
[8]Finsen, V Benmu.P the seeond hip rfactuer An PeidmeiologiestudyAeat OrthoPSena-d,1986,57:431-433.
[9]Luthje.P incidence of hip fracture in Finlnad, A forecast for 1990.Acta Orthop Scand,1985,56:223-225.
[10]Zain-Elabdien BS.olerud S.Karistrom G.The influence of age on the Moprh-ology of trochanteric fracture. Arch OrthoP Trauma Surg,1984,103:156-161
[11]Muller ME,Nazarian S,Koch P.The-ComPrehensive Classification of fractures of the Long Bones.New York, Springer-Verlag,1990.118.
[12]Horwitz BG. Retrospective randomized comparison of the DHS and Gamma locking nail. J Bone Joint Surg.1993:75:789.
[13]唐三元,陈庄洪,徐永年,等.牵引治疗老年股骨粗隆间骨折的评价.中国中医骨伤科杂志,1997,3(6)：33.
[14]Bordle SH, Patel AD, Bireher M. Fixation of intertroehnateric fractures of theFemur.. A randomized Prospective comparison of the gamma nail and the dynamic hip screw. J bone Joint Sugr(B)r,1991,73:330-334.
[15]荣国威,等.骨科内固定.第3版.北京：人民卫生出版社,1995：181
[16]谷避龄,等.130度角钢板治疗股骨粗隆间骨折,骨与关节损伤杂志,1992；7(1)：29-30
[17]李毅,宁士荣,耿硕儒等.股骨矩的解剖和力学研究.解剖学报.1991,2；(3)：235-237.
[18]Galanakis IA, Steriopoulox KA, Dretakis EK. Correct placement of the scereo or nail inTrochanterio fractures [J]. Clinorthop.2004,32(5):148-152.
[19]高令军,裘世静,戴克戎.股骨矩的三维结构和显微结构特征及其力学意义.中华骨科杂志1999,19(2)：109.
[20]荣国威译.骨科内固定(第三版),北京：人民卫生出版社,1995.367.
[21]袁宏,等.95°髁钢板与Richards钉治疗老年转子间骨折.骨与关节损伤,2000,15(4)：305-306.
[22]Parker MJ, Handoll HHG. Gamma and other cephalocondylic Intramedullary nails versus extramedullary implants for extraeaps-ular hip fractures.In the Coehrane Library, issue4.1999.Oxford:update sofeware.
[23]Loch DA, Kyle RE, Bechtold JE, et al.Force required toinitiate sliding in second-generation Intramedullary nails.J BoneJoint Surg(Am),1998:801:1626-1631
[24]BridleSH, Patel AD, BireherM, et al. Fixation of intertr-Oehanteric fractures of the femur. J Bone Joint Surg(Br).1991:73B:330.
[25]Leung KS, So WS, Shen WY, et al.Gamma nail and dynamic hip Serews for peritrochanteric fractures.J Bone Joint Surg,1992:74B:345.
[26]张保中,罗先正,刘长贵,等.Gammaa钉与滑动加压鹅头钉治疗股骨转子间骨折的比较.中华骨科杂志,1997：17(4)：237-239
[27]alder SC, The Gamma nail for prtitrochanteric fractures.J Bone Joint Surg(Br), 1992:74:340-344.
[28]梁雨田.人工股骨头置换治疗老年不稳定性股骨粗隆间骨折.解放军保健医学杂志,2005,7(1)：13-14
[29]方祥仔,利盛成.长柄人工股骨头置换治疗老年股骨粗隆间骨折的临床研究.中国医师杂志,2005,增刊：97-98.
[30]龙树明,吴术红,刘毅,等.人工股骨头置换治疗老年不稳定性股骨粗隆间骨折.实用临床医学,2006,7(4)：57-58
[31]梁雨田,郭义柱,陶笙,等.老年患者非稳定性股骨粗隆间骨折人工股骨头置换术.军医进修学学报,2005,26(1)：4-5
[32]骆剑敏,朱国庆,陈栋,等.高龄不稳定股骨粗隆间骨折人工股骨头置换术治疗体会.中国骨与关节损伤杂志,2006,21(1)：60-61
[2]王亦璁.骨与关节损伤, 北京：人民卫生出版社2006：1179
[3]Horwitz BG. Retrospective randomized comparison of the DHS and Gamma locking nail. J Bone Joint Surg.1993:75:789.
[4]Evans.EM.The treatment of peritrochanteric fracture.J Bone Joint Surg(Br),1949,3 1(2):10
[5]戴魁戎主译.现代骨科学.第1版,北京：科学技术文献出版社,2002,389.
[6]王满宣,贾国胜,安贵生等,股骨近端髓内针(PFN)治疗转子部骨折中华创伤骨科杂志,2004(2)6
[7]卢世壁,董天华等.髋关节外科学第1版郑州大学出版社,2005,259
[8]骨少汀.经矩斯氏针内固定治疗粗隆间骨折.中华外科杂志,1992,30：107
[9]王亦璁.骨与关节损伤, 北京：人民卫生出版社2006：1179
[10]毛宾尧.髋关节外科学,北京：人民卫生出版社,1998.216-219
[11]郭世绂,钟世镇等,骨科临床解剖学,山东科学技术出版社.2002 713-714
[12]危杰.股骨转子间骨折.中华创伤骨科杂志,2004,6：554-557,
[13]Harrington KD.The management of comminuted unstbale intertrochanterie fracurte.J Bone Joint Surg (Am),1993,55:1367-1371.
[14]Buamgaertner MR, Curtin SL, LindskogDM.The value of the tip-apex Distance in Predicting failer of fixation of Peritroochanteric fractueres of the hip. J BoneJoint Sugr(B)r1995,77:1058-1064.
[15]王满宜.加强股骨近端骨折的临床研究.中华创伤骨科杂志.2004,5：481-483
[16]Simmermacher RK. Bosch AM. Van der Werken C.AO/ASIF-proximalfemoral nail(PFN):a new device for treatment of unstable proximalfemoral fractures. Injury,1999,30:327-332.
[17]姜丹青,股骨粗隆间骨折的手术治疗中国医师杂志2003(2)5
[18]EllisTj, KyleRf, The results of open reduction interal fixation of a highly Unstbale interrochanteric hip fracture with a dynamic hip screw. Presented as Aposter exhibit at the Annual Meeting of the Ameriean A cademu of Orthopaedic Sugreons;2000,15-19;Orinado, FL.
[19]周雪峰,马华松,等.动力螺钉治疗股骨粗隆部骨折的并发症及其防治[J].中国矫形外科杂志,2004,12(8)：63 1-632
[20]Simmermacher RK. Bosch AM. Van der Werken C.AO/ASIF-proximalfemoral nail(PFN):a new device for treatment of unstable proximal femoral fractures. Injury,1999,30:327-332.
[21]Koval K, J, Zuckerman JD. Intertrochanteric fractures. In:Bu-cholz RW. Heckman JD. eds. Rockwood and Green' S fractures in adults.5th ed Philadelphia Lippincou Williams&Wilkins.2001.1635-1663.
[22]卢世壁,董天华等.髋关节外科学,郑州大学出版社,2005,260
[23]王澍寰临床骨科学上海科学技术出版社,2005,01：616-618
[1]赵炬才,张铁良.髋关节外科学.北京：中国医药出版社,1992.197-221.
[2]Vilhjalmur, FLasrGJ, Gder, T, et al.Hip rfacuture incidence in cenitral norway:a follow up study.Clin Orthop relat Res,2004,1(419):173-178
[3]危杰,股骨转子间骨折,中华创伤骨科杂志,200；46(5)：554-557
[4]胥少汀,葛宝丰,徐印坎.实用骨科学.北京：人民军医出版社,1999.677.
[5]Evana EM.The treatm ent of trocham feric fractures of the femur.Bone Joint surg,1949,31(2):190-194.
[6]许继刚.股骨转子骨折治疗疗效分析(附438例报告).中华骨科杂志,1999,14(2)：150-151.
[7]Richmond J,Aharonoff GB,Zuekeman JD,et al.Mortality risk after hip fracture[J].J Orthop Trauma,2003,17(1):53-56.
[8]Finsen, V Benmu.P the seeond hip rfactuer An PeidmeiologiestudyAeat OrthoPSena-d,1986,57:431-433.
[9]Luthje.P incidence of hip fracture in Finlnad, A forecast for 1990.Acta Orthop Scand,1985,56:223-225.
[10]Zain-Elabdien BS.olerud S.Karistrom G.The influence of age on the Moprh-ology of trochanteric fracture. Arch OrthoP Trauma Surg,1984,103:156-161
[11]Muller ME,Nazarian S,Koch P.The-ComPrehensive Classification of fractures of the Long Bones.New York, Springer-Verlag,1990.118.
[12]Horwitz BG. Retrospective randomized comparison of the DHS and Gamma locking nail. J Bone Joint Surg.1993:75:789.
[13]唐三元,陈庄洪,徐永年,等.牵引治疗老年股骨粗隆间骨折的评价.中国中医骨伤科杂志,1997,3(6)：33.
[14]Bordle SH, Patel AD, Bireher M. Fixation of intertroehnateric fractures of theFemur.. A randomized Prospective comparison of the gamma nail and the dynamic hip screw. J bone Joint Sugr(B)r,1991,73:330-334.
[15]荣国威,等.骨科内固定.第3版.北京：人民卫生出版社,1995：181
[16]谷避龄,等.130度角钢板治疗股骨粗隆间骨折,骨与关节损伤杂志,1992；7(1)：29-30
[17]李毅,宁士荣,耿硕儒等.股骨矩的解剖和力学研究.解剖学报.1991,2；(3)：235-237.
[18]Galanakis IA, Steriopoulox KA, Dretakis EK. Correct placement of the scereo or nail inTrochanterio fractures [J]. Clinorthop.2004,32(5):148-152.
[19]高令军,裘世静,戴克戎.股骨矩的三维结构和显微结构特征及其力学意义.中华骨科杂志1999,19(2)：109.
[20]荣国威译.骨科内固定(第三版),北京：人民卫生出版社,1995.367.
[21]袁宏,等.95°髁钢板与Richards钉治疗老年转子间骨折.骨与关节损伤,2000,15(4)：305-306.
[22]Parker MJ, Handoll HHG. Gamma and other cephalocondylic Intramedullary nails versus extramedullary implants for extraeaps-ular hip fractures.In the Coehrane Library, issue4.1999.Oxford:update sofeware.
[23]Loch DA, Kyle RE, Bechtold JE, et al.Force required toinitiate sliding in second-generation Intramedullary nails.J BoneJoint Surg(Am),1998:801:1626-1631
[24]BridleSH, Patel AD, BireherM, et al. Fixation of intertr-Oehanteric fractures of the femur. J Bone Joint Surg(Br).1991:73B:330.
[25]Leung KS, So WS, Shen WY, et al.Gamma nail and dynamic hip Serews for peritrochanteric fractures.J Bone Joint Surg,1992:74B:345.
[26]张保中,罗先正,刘长贵,等.Gammaa钉与滑动加压鹅头钉治疗股骨转子间骨折的比较.中华骨科杂志,1997：17(4)：237-239
[27]alder SC, The Gamma nail for prtitrochanteric fractures.J Bone Joint Surg(Br), 1992:74:340-344.
[28]梁雨田.人工股骨头置换治疗老年不稳定性股骨粗隆间骨折.解放军保健医学杂志,2005,7(1)：13-14
[29]方祥仔,利盛成.长柄人工股骨头置换治疗老年股骨粗隆间骨折的临床研究.中国医师杂志,2005,增刊：97-98.
[30]龙树明,吴术红,刘毅,等.人工股骨头置换治疗老年不稳定性股骨粗隆间骨折.实用临床医学,2006,7(4)：57-58
[31]梁雨田,郭义柱,陶笙,等.老年患者非稳定性股骨粗隆间骨折人工股骨头置换术.军医进修学学报,2005,26(1)：4-5
[32]骆剑敏,朱国庆,陈栋,等.高龄不稳定股骨粗隆间骨折人工股骨头置换术治疗体会.中国骨与关节损伤杂志,2006,21(1)：60-61