髓内钉治疗不同类型转子间骨折的对比研究

Comparison of different femoral intertrochanteric fracture treated with intramedullary nail for elderly patients

摘要:

目的 探讨应用髓内钉内固定治疗难复性和易复性股骨转子间骨折的临床疗效。方法 选取 2013 年2 月—2015 年7 月在天津市北辰医院接受髓内钉治疗的60 例老年股骨转子间骨折患者的临床资料， 根据骨折类型分为难复组和易复组。难复组患者28 例，利用骨膜剥离器辅助复位后行髓内固定；易复组患者 32 例，常规行闭合复位髓内钉内固定。记录两组患者手术时间、出血量、住院时间、复位优良率及并发症等 指标。患者术后3 个月、1 及2 年进行定期随访，采用ZUCKERMAN 髋部骨折恢复量表（FRS）和欧洲五 维健康量表（EQ-5D）评估患者关节功能和生活质量。末次随访时采用视觉疼痛模拟评分（VAS）评估患者 髋部疼痛程度。结果 易复组患者手术时间短于难复组（P <0.05），围术期总体出血量少于难复组（P <0.05）。 两组患者住院日、复位优良率及并发症发生率比较，差异无统计学意义（P >0.05）；两组无患者发生切口感染、 骨折不愈合、延迟愈合及内固定松动等并发症。末次随访时易复组患者关节功能优于难复组（P <0.05）；但 两组患者生活质量及独立行走能力比较，差异无统计学意义（P >0.05）。结论 应用髓内钉内固定治疗股骨 转子间骨折可取得满意的临床疗效。与易复性骨折比较，难复性骨折手术操作复杂，创伤较大，整体疗效略差。

Abstract:

Objective To compare the clinical results between irreducible and reducible femoral intertrochanteric fracture with intramedullary nail for elderly patients. Methods A total of 60 elderly patients with femoral intertrochanteric fracture who underwent intramedullary nail fixation were enrolled in this study from February 2013 to July 2015. According to fracture type the patients were divided into irreducible group and reducible group. Periosteal dissector was applied to make reduction and then fixed with intramedullary nail for 28 cases in irreducible group. Routine closed reduction and intramedullary nail fixation was performed for 32 patients in reducible group. The operation index, fracture reduction, complication rate and bed days were recorded for both groups. The hip function and quality of life were evaluated by functional recovery scale (FRS) and EuroQol 5 dimensions scores (EQ-5D). All the patients were followed up by outpatient and telephone in 3 months, 1 year and 2 years periodically. Results The operation time and amount of blood loss were less in reducible group (P < 0.05). While the bed days, complication rate and fracture reduction were similar between the 2 groups (P > 0.05). At the last follow-up the FRS was higher in reducible group (P < 0.05), however the EQ-5D index and independent walk capability showed no significant difference between the 2 groups (P > 0.05). Conclusions Intramedullary nail was effective treatments for elderly patients with femoral intertrochanteric fracture. While the clinical outcome favored reducible group with less surgical procedure and trauma.