股骨转子间骨折的手术治疗分析

Analysis on operative treatment of intertrochanteric hip fractures

目的：分析股骨转子间骨折内固定治疗的疗效，以提高各型内固定方法在股骨转子间骨折治疗中的临床效果。方法：1999年8月-2004年11月，对127例股骨转子间骨折内固定手术病例进行跟踪随访，评定疗效。本组男73例，女54例；年龄31～86岁，平均56、6岁。按照Evans分型：Ⅰ型17例，Ⅱ型39例，Ⅲ型18例，Ⅳ型42例，Ⅴ型11例。其中动力髋螺钉（DHS）固定48例，股骨近端解剖型钢板固定27例，Gamma钉固定23例，股骨近端钉（PFN）固定21例，双头空心加压螺纹钉固定8例。结果：所有患者均获得随访，时间8～62个月（平均31．2个月），根据Harris评定标准，DHS固定48例中优29例，良12例，可5例，差2例，优良率为85．4％；股骨近端解剖型钢板固定27例中优15例，良8例，可3例，差1例，优良率为85．2％；Gamma钉固定23例中优13例，良7例，可2例，差1例，优良率为87.0％；PFN固定21例中优15例，良5例，可1例，差0例，优良率为94．8％；双头空心加压螺纹钉固定8例中优4例，良2例，可1例，差1例，优良率为75．0％。127例总的评价结果：优76例，良34例，可12例，差5例，总优良率为86.6％（110／127）。并发进钉点股骨转子间再骨折3例，髋内翻畸形7例，螺钉切出股骨颈2例，股骨干骨折1例，大腿中上部疼痛2例，切口感染3例。结论：对股骨转子间骨折的治疗，根据骨折类型和条件选择合适的内固定方式，均获得较满意疗效。

Objective： To improve clinical results of interochanteric hip fractures with various kinds of internal fixation by analyzing the effect of internal fixation of interochanteric hip fractures. Methods： From August 1999 to November 2004, 127 patients with interochanteric hip fractures were followed. There were 73 male and 54 female, with a mean age of 56. 6 years （ ranged from 31 to 86 years）. According to Evans classification,there were 17 type Ⅰ ,39 type Ⅱ ,18 type Ⅲ ,42 type Ⅳ ,and 11 type Ⅴ. They were respectively treated with five kinds of operations：48 patients with dynamic hip screw （DHS） ,27 patients with proximal femoral anatomical plate ,23 patients with Gamma nall ,21 patients with proximal femoral nail（ PFN ） ,8 patients with tow-way cannulated compressive screw. Results： All 127 patients were followed （ranged ,8 to 62 months）, with an average of 31.2 months. According to Harris criterion, among 48 patients treated with DHS ,29 got an excellent result, 12 good,5 fair, 2 poor, the rate of excellent and good was 85.4% ;among 27 patients treated with proximal femoral anatomical plate, 15 had an excellent resuh,8 good,3 fair,1 poor,the rate of excellent and good was 85. 2% ;among 23 patients treated with Gamma nail： 13 got excellent resuh,7 good,2 fair, 1 poor,the rate of excellent and good was 87.0% ;among 21 patients treated with PFN, 15 had an excellent result,5 good, 1 fair,0 poor, the rate of excellent and good was 94. 8 % ;among 8 patients treated with towway cannulated compressive screw,4 excellent,2 good,1 fair,1 Door,the rate of excellent and good was 75.0%. As a total, 76 patients had an excellent result,34 good, 12 fair,5 poor, the excellent and good rate of the function of the hip joint was 86.6% （110/127）. And there were 3 patients with re-fracture of interochanteric hip at interlocking sit,7 patients with varus malunion ,2 patients with screw cutting out femoral neck, 1 patient with femoral shaft fracture ,2 patients with femoral upper or middle pain and 3 patients with wound infection. Conclusion： For the interochanteric hip fractures, we can get satisfactory effects by choosing proper internal fixation methods based on the styles and conditions of various fractures.