不同手术和内固定方式治疗髋部骨折疗效分析

The comparison for various kinds of surgical management of hip fractures

目的探讨不同手术和内固定方式在髋部骨折治疗中的意义。方法对168例髋部骨折分别采用动力加压髋螺钉（DHS）、股骨近端解剖钢板、Gamma钉、股骨近端髓内钉（PFN）、3枚空心钉内固定和人工髋关节假体置换治疗。结果经术后6～60个月随访，股骨转子间骨折中，DHS组优良率为85．7％，解剖钢板组优良率为83．3％，PFN组优良率为96．2％；股骨转子下骨折内固定手术优良率为93％；股骨颈骨折中人工关节置换组优良率为94．3％，3枚空心钉组优良率为75％，DHS组优良率为88．9％。结论PFN是治疗股骨转子间和转子下骨折的最牢固内固定方式，人工关节置换是治疗股骨颈头下型骨折和老年股骨颈骨折的主要方法，也是术后继发股骨头坏死治疗的主要补救措施。

Objective To explore the significance of various kinds of surgical management and internal fixations of hip fractures. Methods 168 cases with hip fractures were treated with dynamic hip screw（DHS）,proximal femoral anatomic plate, gamma nail, proximal femoral nail（PFN ）, three cannulated screws and artificial joint replacement respectively. Results 168 eases with hip fractures were followed up for 6 - 60 months, to treat intertrochanteric fractures of femur, the excellent and good rate with DHS was 85.7%, the excellent and good rate with proximal femoral anatomic plate was 83.3 %, the excellent and good rate with PFN was 96.2 % ;To treat subtrochanteric fractures of femur with internal fixation, the excellent and good rate was 93 % ;To treat the femoral neck fracture.the excellent and good rate with artificial joint replacement was 94.3 %, the excellent and good rate with three cannulated screws was 75 96, the excellent and good rate with DHS was 88.9 96. Conclusion PFN is the best internal fixation for the treatment of intertrochanteric fractures and subtrochanteric fractures of femur：And artificial joint replacement is mainly applicable to treating the femoral neck fracture especially the aged patients, and it is the main remedy measure for treating the femur head necrosis occurred after operation.