微创复位技术治疗复杂性股骨粗隆间骨折的疗效分析

Therapeutic effects of minimally invasive replacement in complicated femoral intertrochanteric fractures

[目的]评价微创复位技术治疗复杂性股骨粗隆间骨折的疗效。[方法]本科自2005年3月-2008年8月对49例复杂性股骨粗隆间骨折患者，按复位方式的不同，将其分为A组：切开复位组（21例）；B组：微创技术复位组（28例）。同时采用PFN、Gamma钉内固定治疗。术中记录手术时间、出血量；术后情况及随访记录住院时间、负重时间、骨折平均愈合时间、并发症以及髋关节功能恢复情况。[结果]所有患者均获随访，随访时间12～36个月（平均23．3个月）。B组在手术时间、出血量及骨折平均愈合时间较A组有统计学意义上的差异（P〈0．05）。术后髋内翻畸形、内固定断裂、股骨干骨折、肢体短缩等并发症的发生率在两组间无统计学意义上的差异（P〉0．05）。B组髋关节功能评分（Harris）优良率明显高于A组（P〈0．05）。[结论]采用微创复位技术，利用复位钳环抱间接复位加内固定治疗复杂性股骨粗隆间骨折，复位佳，术中创伤小，术后骨折愈合时间缩短，髋关节功能恢复良好。

[ Objective ] To evaluate the therapeutic effects of minimally invasive replacement in complicated femoral intertrochanteric fractures. [ Method] A retrospective analysis was done for 49 patients with femoral intertrochanteric fractures in the author＇s department from March 2005 to August 2008. According to different ways of replacement, the patients were divided into Group A （ n = 21 ）, open repositioning and Group B （ n = 28 ）, minimally invasive replacement respectively. And PFN or Gamma nail was fixed after that. Operation time, bleeding volume, length of stay, time of weight loading and average time of fracture union, incidence rate of complications and hip function were recorded. [ Result ] There great significant differences in operation time, bleeding volume and average time of fracture union between Group B and Group A respectively （P 〈 0.05 ）. And there was no significant difference in the incidence rate of complications, such as hip varus, fracture of fixation, femoral shaft fractures,limb shortening between groups （ P 〉 0.05 ）. Hip score （Harris） in Group B was significantly higher than that in group A （ P 〈 0. 05 ）. [ Conclusion] Minimally invasive replacement with indirect reduction and internal fixation has advantages of less truma, short fracture union time and better hip function in treatment of complicated intertrochanteric fracture.