股骨粗隆间骨折不同内固定方法的回顾性比较

Retrospective study of comparing the different internal fixation methods in treating intertrochanteric fracture of femur

目的:比较不同内固定方法在治疗股骨粗隆间骨折中的优缺点,探讨股骨粗隆间骨折内固定选择的策略。方法:股骨粗隆间骨折患者326例行内固定手术,其中动力髋螺钉(dynamic hip screw)固定(DHS组)165例,男78例,女87例,年龄38～98岁;股骨近端解剖钢板(anatomic plate)固定(AP组)103例,男48例,女55例,年龄39～89岁;可膨胀股骨近端钉(proximal femoral nail)固定(PFN组)58例,男31例,女27例,年龄41～92岁。根据Evans股骨粗隆间骨折分型分为I、II、III、IV型及逆粗隆间骨折共5型,各组病例数分别为DHS组(12、35、61、42、15),AP组(9、23、38、25、8),PFN组(6、13、21、13、5)。比较上述3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、术后功能评分、手术并发症等方面的结果。结果:DHS、AP和PFN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、术后功能评分等方面差异有统计学意义(P<0.01),PFN组较DHS、AP组手术时间缩短、术中出血量和术后引流量少、骨折临床愈合时间缩短、术后功能恢复好,但术中X线暴露次数明显多。各组手术并发症的差异无统计学意义(P=0.05)。结论:可膨胀股骨近端钉在治疗股骨粗隆间骨折中具有一定的优势。

Objective：To investigate the selective strategy of the internal fixation methods in treating intertrochanteric femoral fracture by comparing the different methods. Methods：Data of 326 cases of intertrochanteric femoral fractures treated with different internal fixation methods were concluded. One hundred and sixty-five cases were treated with the dynamic hip screws （DHS group） ,78 male,87 female,age 38 to 98 years. One hundred and three cases were treated with the anatomical plates of proximal femur （AP group）, 48 ma 1 e, 55 female, age 39 to 89 years. Fifty-eight cases were treated with the fixation expandable proximal femoral nails （PFN group）, 31 male, 27 female, age 41 to 92 years. According to Evans classification of intertrochanteric femoral fractures,fractures were divided into type Ⅰ, Ⅱ, Ⅲ, Ⅳ and retro-intertrochanteric type. The cases of each type of three groups were DHS（12,35,61,42,15） ;AP（9,23,38,25,8 ） ;PFN （6,13,21,13,5）. Data of each group was collected for statistical analysis on the following aspects ：operation time ,blood loss ,fluoroscopy exposures,drainage ,clinical healing time of fracture, post-operative restored function and the total complications. Results：The difference of operation time, blood loss, fluoroscopy exposures, drainage, clinical healing time of fracture, post-operative restored function were of statistical significance （P〈0.01）. In comparing with group DHS and AP, group PFN was of less operation time, blood loss, drainage, clinical healing time of fracture ,but more fluoroscopy exposures ,and the post-operative restored function of group PFN was more satisfied. The difference of operative complications were of no statistical significance （P=-0.05）. ConcIusion ：The fixation expandable proximal femoral nail is a good choice for intertrochanteric femoral fracture.