MIPPO结合DHS治疗老年股骨粗隆间骨折
MIPPO结合DHS治疗老年股骨粗隆间骨折 【摘要】 [目的]利用MIPPO微侵入经皮钢板植入技术植入DHS治疗老年股骨粗隆间骨折,以减少手术所造成的创伤反应。[方法]回顾性分析本院2004年7月~2005年10月收治的75例老年股骨粗隆间骨折,内固定材料均选用DHS,其中29例采用MIPPO置入,46例采用常规切口置入,比较两种手术方式的创伤程度。主要考察指标:手术切口长度、术中出血量、术中及术后输血量、术后血红蛋白下降幅度、术后术区肢体肿胀情况、血沉等来反映手术中创伤大小。[结果]MIPPO组手术切口平均长度为 cm,常规组为 cm。MIPPO组失血少,术中及术后无需输血,术后血红蛋白下降幅度小,术后患肢肿胀轻,消肿快, ESR恢复快,卧床时间短。围手术期死亡2例,其余患者均顺利出院,获7~21个月随访,平均个月。1例在随访期间死于其他内科疾病,其余所有骨折均愈合,平均愈合时间为个月(常规切口组)和3、4个月(MIPPO组),两组骨折愈合时间无显着性差异。[结论]采用小切口技术植入DHS内固定治疗老年股骨粗隆间骨折手术创伤小,有利于患者全身状况和肢体功能的恢复。 【关键词】 股骨; 粗隆间骨折; 微创; 动力髋部螺钉 Using Minimally invasive percutaneous plate osteosynthesis and DHS for fixation of intertrochanteric hip fractures in elderly patients∥ Abstract:[Objective]To investigate the effect of using Minimully invasive percutuneous plate osteosunthosis to insert DHS for fixation of intertrochanteric hip fractures in elderly patients,in order to reduce operative trauma. []To study retrospectivly 75 cases of the intertrochanteric fracture of elderly patients treated with DHS,these patients were treated from july to october MIPPO was used in 29 out of 75 cases,classic technique for fixation was used in other ones.[Result]All patients successfully discharged except two died because of fungal septicemia and lung 73 cases were followed up from 7 to 21 months (averagd months),one died of morbus internus in follow-up period. All the fractures had successful union,union time in average was months,the diference between MIPPO group and classic incision group was not distinguished. Blood loss and transfusion in MIPPO group was less than classic incision of ESR and detumescence of the femoral was quickly in minimal incision group,time in bed was short.[Conclusion]Technique of minimal invasive fixation using DHS has little trauma and quick functional recovery for patients,therefore,this technique should be better for treatment of intertrochanteric fracture in elderly patients. Key words:femoral; intertrochanteric fracture; minimal invasive; dynamic hip screw 随着人口老龄化,股骨粗隆间骨折发病率逐年增加。DHS是目前治疗粗隆间骨折公认较理想的方法,但常规切开复位内固定对老年患者创伤较大,术后功能往往恢复较慢。本院自2004年7月~2005年10月采用MIPPO结合DHS治疗29例老年股骨粗隆间骨折,取得满意效果。 1 材料与方法 一般资料 本组75例,男32例,女43例,年龄65~101岁,平均79岁,全部为摔倒致伤。AO分型:A1型33例,A2型42例。大部分患者存在不同程度骨质疏松,9例合并桡骨远端和或者脊椎骨折。有55例合并至少1种内科疾病,最多合并4种内科疾病,主要内科疾病为高血压,冠心病,糖尿病,慢性支气管炎,老年痴呆等。入院后均先采用胫骨结节牵引,请内科医师协助治疗内科疾患,并请麻醉科会诊作术前评估。术前患者血压控制在临界值,HGB纠正至90g/L以上,血糖控制在 mmol/L以下,纠正低蛋白血症并应用抗生素。于受伤后2~7 d,平均 d手术。29例采用MIPPO置入DHS,46例采用常规切口置入。 手术方法 主要采用腰硬联合或气管插管麻醉,合并有呼吸系统疾病者尽量不采用气管插管麻醉。手术在骨科牵引床上进行,患肢伸直、外展、内旋、健侧肢体外展固定。C型臂透视证实骨折复位后开始消毒铺单。如果不能完全复位,则在术中以骨膜剥离子协助复位。 常规切口组自大转子上2 cm至远侧,长10~12 cm,切开皮肤、髂胫束及股外侧肌,暴露大转子下及近段股骨外侧,打入导针,扩孔,攻丝,安装上滑动加压螺钉和套筒钢板。冲洗创口,逐层缝合,不放置引流。记录术中出血量和输血量。 MIPPO组 首先在患侧髋部前方放置1根导针, C型臂X线机正位透视下调整克氏针位置,使克氏针方向与股骨颈中轴线平行并位于其内下方。于股外侧平行于股骨干放置另1根克氏针,侧位透视使该克氏针位于大转子前后缘中央,并与股骨干方向一致。沿克氏针在皮肤上作标记,以第1根克氏针与股外侧皮肤交点向第2根克氏针做垂线,其交点即为导针的皮肤入点。确定入针点后,经皮向股骨颈内打入导针,C臂透视确定位置良好后开始做切口。切口有两种方式,一种是连续切口,另一种为间断切口。连续切口自导针入点向远端作4~6 cm长的切口,髂胫束切开略长于皮肤切口,切开骨外侧肌。测量所需加压螺钉长度,以三联扩孔器钻孔,攻丝,拧入滑