股骨转子间骨折的内固定手术疗效比较

A Clinical result of treatments for femoral intertrochanteric fracture with operative approaches

目的通过比较髓内固定和髓外固定股骨转子间骨折的治疗,探讨转子间骨折的手术适应症。方法1997年9月～2007年2月收治的360例股骨转子间骨折手术的病人,髓内固定组:Gamma钉内固定71例,短重建钉固定48例,股骨近端髓内钉(PFN)和股骨近端髓内钉-螺旋刀片(PFNA)固定78例。髓外固定组:动力髋螺钉(DHS)固定139例和动力髁螺钉固定(DCS)24例。结果本组360例中,11例术后5个月内死亡。其余349例获得5-36个月(平均13个月)随访,两种术式与术中出血量和手术时间明显相关,与术后主要并发症、骨折愈合时间和Harris功能评分无明显相关。结论髓内固定和髓外固定治疗股骨转子间骨折疗效确切,并发症发生率低,但髓内固定更适用于复位后不稳定的转子间骨折。

Objective To explore the operative indications for femoral intertrochanteric fractures by extramedullary internal fixation system and intramedullary internal fixation system. Methods All the 360eases of intertrochanteric fractures who had been treated from september, 1997 to February, 2007 in two hospitals. Intramedullary internal fixation groups include Gamma nails （71eases）, Reconstruction nails （48cases）, PFA and PFNA （78cases）. extramedullary internal fixation groups include DHS（139eases） and DCS（24eases）. Results Of the 360 cases ,11 died 5 months ,after operation. The rest 359 caseswere followed up for an average of 13 months （range, 5 to 36months）.There was significant correlation between blood loss,operative time and operative method. There was no significant between eomplietions, union time ,Han＇is score and operative method. Conclusion Extramedullary internal fixation system and intramedullary internal fixation system can be applied for intertroehanteric fractures with satisfactory sffects and lower complications .While intramedullary internal fixation system is applied for instable fracture after replacement especially