傅升培　黄祥文　李泽添

【摘要】 目的：探討老年股骨粗隆间骨折不同手术治疗的效果，分析患者预后相关影响因素。方法：收集2018年5月-2019年5月笔者所在医院治疗的老年股骨粗隆间骨折患者，按手术方式微创内固定系统（LISS）、滑动加压动力髋螺钉（DHS）及股骨近端防旋髓内钉（PFNA）分为三组，每组20例。比较三组手术相关指标（手术时间、术中失血量、骨折愈合时间、住院时间及术后并发症等），并采用Harris评分法评价患者1、3、6个月的髋关节功能。并对比分析Harris评分>70患者与Harris评分<70患者的基本资料，采用多元Logistic回归分析患者预后的影响因素。结果：（1）手术时间、术中失血量由高至低分别为DHS组、LISS组、PFNA组，且差异均有统计学意义（P<0.05）。PFNA组的住院时间、术后并发症率均显著少于LISS组与DHS组（P<0.05），LIIS组与DHS组差异无统计学意义（P>0.05）;LISS组患者骨折愈合时间稍长于DHS及PFNA组，但三组差异无统计学意义（P>0.05）。（2）PFNA组术后1个月、3个月Harris评分显著优于LISS组及DHS组（P<0.05）。三组患者术后6个月Harris评分差异无统计学意义（P>0.05）。（3）Harris评分>70患者的年龄、骨折分型、术后首次负重时间、术后并发症率等与Harris评分<70患者比较，差异有统计学意义（P<0.05）;Logistic分析发现骨折分型、术后首次负重时间是影响患者预后的影响因素。结论：PFNA术治疗老年股骨粗隆间骨折的效果要优于LISS术与DHS术，具有更小手术创伤、更少并发症率，对患者预后恢复效果更佳。骨折分型与术后首次负重时间是影响患者预后的影响因素。

【关键词】 老年 股骨粗隆间骨折 手术 因素

doi：10.14033/j.cnki.cfmr.2020.21.051 文献标识码 B 文章编号 1674-6805（2020）21-0-04

Analysis of the Operative Effect and Prognostic Factors of Intertrochanteric Fracture in the Elderly/FU Shengpei， HUANG Xiangwen， LI Zetian. //Chinese and Foreign Medical Research， 2020， 18（21）： -126

[Abstract] Objective： To explore the operative effect and prognostic factors of intertrochanteric fracture in the elderly. Method： The elderly patients with intertrochanteric fracture of femur treated in our hospital from May 2018 to May 2019 were divided into three groups according to LISS operation， DHS operation and PFNA operation， 20 in each group. The operation related indexes （operation time， intraoperative blood loss， fracture healing time， hospitalization time and postoperative complications） were compared among the three groups. The hip joint function of patients at 1， 3 and 6 months were evaluated with Harris scoring method. The basic data of patients with Harris score>70 and patients with Harris score<70 were compared， and the influencing factors of prognosis were analyzed by multiple Logistic regression. Result： （1） The operation time and blood loss during operation from high to low were DHS group， LISS group and PFNA group respectively， and the difference was statistically significant （P<0.05）. The hospitalization time and postoperative complication rate of PFNA group were significantly lower than those of LISS group and DHS group （P<0.05）， but there was no significant difference between LISS group and DHS group （P>0.05）. The fracture healing time of LISS group was slightly longer than that of DHS group and PFNA group， but there was no significant difference among the three groups （P>0.05）. （2） The Harris score of PFNA group was significantly better than that of LISS group and DHS group after 1 month and 3 month （P<0.05）. There was no significant difference in Harris score between the three groups after 6 month （P>0.05）. （3）There were significant differences in age， fracture classification， time of first postoperative weight-bearing and postoperative complication rate between patients with Harris score>70 and those with Harris score<70 （P<0.05）. Logistic analysis showed that fracture classification and the time of first postoperative weight-bearing were the factors influencing the prognosis of patients. Conclusion： PFNA is better than LISS and DHS in the treatment of intertrochanteric fracture of femur in the elderly. It has less surgical trauma， less complication rate and better effect on the prognosis of patients. Fracture classification and the time of first postoperative weight-bearing are the factors influencing the prognosis of patients.

[Key words] The elderly Intertrochanteric fracture Operation Influence

First-authors address： Yunan Peoples Hospital， Yunan 527199， China

老年人骨质疏松，骨强度下降，受到外伤后更易出现骨折。股骨粗隆间骨折是我国老年人常见的骨折现象，发生率高。但是由于老年人机体恢复能力差，对于手术的耐受性普遍不高，因此部分患者多采用保守治疗[1-2]。保守治疗虽然可以保证患者免受手术痛苦，但长期的卧床会影响患者髋关节功能恢复，而且会引起其他相关症状如吸入性肺炎、褥疮等。随着近年来骨科医学技术的发展，衍生出多种股骨粗隆间骨折手术方式，而且不乏发展出更适合于老年人的手术治疗方式。目前常用固定方式有微创内固定系统（less invasive stabilization system，LISS）、滑动加压动力髋螺钉（dynamic hip screw，DHS）及股骨近端防旋髓内钉（proximal femoral nail anti-rotation，PFNA）等，不过手术方式不同，手术相关指标及预后可能有所不同[3-5]。而老年人多合……