股骨粗隆间骨折的不同手术方式的疗效比较

The comparison of the different surgical methods to treat intertrochanter fracture of femur

目的探讨不同手术方式治疗股骨粗隆间骨折的效果。方法对75例股骨粗隆间骨折的患者分别进行动力髋螺钉（DHS）内固定、Gamma钉内固定和动力髁螺钉（DCS）内固定。术后根据创伤性髋关节评分标准，对各组患者进行评价，并比较这三种治疗方法在手术时间、术中出血量、负重时间及愈合时间方面的差异。结果按照创伤性髋关节评分标准，DHS组的总优良率为76．67％，Gamma钉组为76．92％，DCS组为78．95％，经统计学分析后，无显著性差异（P〉0．05）。对于A1型骨折和A2型骨折三种手术方式的疗效相当（P〉0．05），但是对于A3型骨折，DHS组和DCS组比较，DCS组明显优于DHS组（P〈0．05）。而在平均手术时间、术中平均出血量、平均负重时间、平均骨折愈合时间中均没有差异（P〉0．05）。结论对于A1、A2型骨折，三种方法均可行，而且DHS内固定方法是最为简单和最容易操作的；但是对于A3型骨折，Gamma钉和DCS是一个不错的选择，而DCS具有良好的抗弯、抗扭、抗剪力及抗旋转性能，更是值得推荐的一种方法。

Objective To evaluate the clinical effects of the different surgical methods to treat intertrochanter fracture of femur. Methods 75 patients with ntertrochanter fracture of femur were treated with dynamic hip screw（DHS） or Gamma nail or dynamic condyle screw（DCS）.They were evaluated excellent, good and poor with the Sander＇ evaluation criteria, and comparaed in the operation time, blood loss, weight loading time and healing time. Results The excellent rate of DHS was76.67%, and the excellent rate of Gamma nail was 76.92%, the excellent rate of DCS wasYS. 95%,there was not a statistically significant difference between the three methods （P〉0. 05）. Three methods had the same effect to treat type Ⅰ and type Ⅱ,but the group of DCS was higher than the DHS for type Ⅲ, there was a statistically significant difference between the two methods （P〈0.05）. there was not a statistically significant difference in the operation time, blood loss, weight loading time and healing time （P〉0.05）. Conclsion For type Ⅰ and type Ⅱ, DHS is a best choice because it is simplest and easiest to operate , but for type Ⅲ, DCS has the good preformance of resisting bending, torsion and rotation. DCS is worthy of recommending.