动力髋螺钉与解剖型钢板治疗股骨转子下骨折疗效比较

Comparison between dynamic hip screw and anatomical plate for femoral subtrochanteric fracture

目的比较动力髋螺钉(DHS)与解剖型钢板内固定治疗股骨转子下骨折的疗效。方法将54例股骨转子下骨折患者分为两组,DHS内固定治疗29例,解剖型钢板内固定治疗25例,比较两组术后并发症和治疗效果。结果 DHS组获随访25例,术后并发髋内翻2例,螺钉穿出股骨头颈1例。钢板组获随访19例,术后并发髋内翻4例,螺钉松动2例,螺钉穿出股骨头颈1例,下肢深静脉血栓1例。按朱孟勇等疗效判断标准:DHS组优13例,良10例,可2例;钢板组优8例,良6例,可2例,差1例。两组的术后并发症和治疗效果比较,差异有统计学意义(P<0.05)。结论股骨转子下骨折采用DHS系统内固定疗效明显优于解剖型钢板内固定。DHS系统内固定操作简单,术后并发症少,疗效可靠,安全性能高,特别适合在基层医院应用。

Objective To study the methods and the clinical effect of treatment of dynamic hip screws（DHS）and anatomical plate in the treatment of femoral subtrochanteric fracture.Methods 54 patients with femoral subtrochanteric fractures were randomized into 2 groups（DHS,29 cases）,（anatomical plate,25 cases）.The postoperative complications and effect were compared.Results DHS group were followed up for 25 cases.Postoperative complications included hip varus deformity in 2 cases and screw cutout of femoral head and neck in 1 case.Anatomical plate group were followed up for 19 cases.Postoperative complications included hip varus deformity in 4 cases,screw loosening in 2 cases,screw cutout of femoral head and neck in 1 case,and deep veins of lower limb in 1 case.According to Zhu Men-yong＇s classification,DHS groups of the results were excellent in 13 cases,good in 10 cases,and fair in 2 cases;anatomical plate groups of the results were excellent in 8 cases,good in 6 cases,fair in 2 cases;and poor in 1 case.There were significant differences in statistics between the two groups in postoperative complications and treated effect（P0.05）.Conclusions The clinical effect in femoral subtrochanteric fracture treated with DHS interal fixation is better than anatomical plate interal fixation,and DHS internal fixation is simple,with fewer complications,reliable clinical effect,and safety,especially suitable application for basic level hospital.