股骨转子间骨折不同手术方法比较

The comparison for various kinds of internal fixations of intertrochanteric hip fractures

目的比较股骨转子间骨折不同内固定方式的疗效,探讨内固定选择在股骨转子间骨折治疗中的意义。方法1998年2月至2003年5月在上海第六人民医院分别接受角钢板(A组)、动力髋螺钉(DHS,B组)、Gamma钉(C组)、股骨近端钉(PFN,D组)内固定手术治疗的四组、共169例股骨转子间骨折患者,从手术时间、术中出血量、术中并发症、术中X线暴露次数、术后引流量、骨折临床愈合时间、术后功能恢复程度、术后并发症等方面比较各组的结果。结果A、B组和C、D组在手术时间、术中出血量、术中X线暴露次数、术后引流量、骨折临床愈合时间等方面差异有统计学意义(P<0.01),与A、B组相比,C、D组手术时间短,术中出血量及术后引流量少,骨折临床愈合时间缩短,但术中X线暴露次数增加。A、B、D组和C组相比在术中并发症方面差异有统计学意义(P<0.05),C组较高。A组和B、C、D组相比在术后功能恢复程度方面差异有统计学意义(P<0.01),A组较差。各组的术后并发症差异无统计学意义(P>0.05)。结论对ⅠA型无移位和ⅠB型部分移位的骨折,应用四种内固定皆可;对Ⅱ、Ⅲ型骨折,适用Gamma钉和PFN;对Ⅱ、Ⅲ型中骨折线未累及小转子水平的股骨外侧皮质者,亦可应用DHS结合大转子张力带或大转子外侧支撑钢板内固定;对大转子处呈冠状面骨折者。

Objective To explore the significance of optional internal fixations of intertrochanteric hip fractures by comparing the effects of various kinds of internal fixations. Methods From February 1998 to May 2003, 169 cases with intertrochanteric hip fractures were followed up. They were treated with the followed four kinds of operations respectively: angled blade plate (group A), dynamic hip screw (DHS, group B), Gamma nail (group C), proximal femoral nail(PFN, group D). The data of each group were collected for statistical analysis on the following aspects: operative time, blood loss, intraoperative complications, fluoroscopy exposures, drainage, clinical healing time of fracture, post-operative restored function and complications. Results The differences of the operative time, blood loss, fluoroscopy exposures, drainage and clinical healing time between group A, B and group C, D were of statistical significance(P< 0.01). In comparing with group A, B, group C, D was of shorter operative time and clinical healing time, fewer blood loss and drainage, but of more fluoroscopy exposures. The differences of intraoperative complications between group A, B, D and group C were of statistical significance(P< 0.05), group C was of higher rate of intraoperative complications. The differences of the post-operative restored function between group A and group B, C, D were significant in statistics(P< 0.01), group A was less satisfactory. The differences in post-operative complications between all groups were of no statistical significance(P >0.05). Conclusion By comparison, for type ⅠA and ⅠB, angled plate, DHS, Gamma nail and PFN are all applicable. For type Ⅱ and Ⅲ, Gamma nail and PFN are suitable. For some cases of type Ⅱ and Ⅲ in which the outer cortical bone for insertion are intact, DHS combined with tension band or buttress plate of major trochanter is suggestive. The intertrochanteric fracture plane showing a coronal position can not use angled blade plate and DHS, but Gamma nail and PFN are appropriate. For reversed intertrochanteric fracture, angled blade plate, Gamma nail and PFN all can be used.