股骨粗隆间骨折的AO分型与治疗对策

Treatment based on AO classification of thighbone intertrochanteric fracture

目的:探讨各种股骨粗隆间骨折的最佳手术选择方法.方法:106例股骨粗隆间骨折,据AO分型,分别采用6种不同术式,进行讨论.结果:随访6个月～4年,固定组全部骨性愈合,股骨头置换组近期疗效满意.按黄公怡疗效评定法评定:本组优77例,良25例,差4例,疗效满意.结论:对31-A1、31-A2.1型选择DHS内固定,对31-A2.2型、31-A2.3型、3l-A3.3型选择DHS-TSP-防旋钉组合内固定;对3l-A3型选择DCS或PFN内固定;对DHS内固定失效二次翻修选择DCS内固定;对术前需内科干预才能耐受手术且时间不宜过长的31-A1型选择小切口3枚空心钉内固定;对31-A2、31-A3型选择双极人工股骨头置换术.

Objective:to explore the optimal surgical method for thighbone intertrochanteric fractures. Method: Based on AO classification, 106 thighbone intertrochanteric fracture cases were treated with 6 internal fixation methods. The curative effects were analyzed. Result: All cases were followed up for 6~48 months. All the bones healed up in the fixation group while the curative effect were satisfying in the femoral head replacement group. According to Huang Gongyi rating scale, the results showed 77 excellent cases, 25 good cases and 4 poor cases respectively. Conclusion: DHS internal fixation is suitable for 31-A1, 31-A2.1; DHS, TSP and anti-rotation screw internal fixation is suitable for 31-A2.2, 31-A2.3,31-A3.3; DCS or PFN internal fixation is suitable for 31-A3; DCS internal fixation is suitable for DHS fixation failure cases; the 31-A1 cases which need medical intervention preoperatively should be fixed with 3 hollow screws ; bi-pole artificial femoral head replacement is suitable for 31-A2, 31-A3.