动力髋螺钉、Gamma钉、外固定架3种固定物治疗老年股骨转子间骨折

Elderly intertrochanteric fractures treatment using dynamic hip screw,Gamma nail and external fixation frisket

背景:临床常用动力髋螺钉、Gamma钉、外固定架治疗老年股骨转子间骨折,但如何选择尚没有一个标准可供参考。目的:比较动力髋螺钉、Gamma钉、外固定架3种内固定物治疗老年股骨转子间骨折的效果。方法:对168例老年股骨转子间骨折分别采用动力髋螺钉内固定53例,Gamma钉内固定58例,外固定架57例,比较3组手术时间、出血量、骨折愈合时间和术后并发症,观察术后关节功能。结果与结论:术后随访6～35个月。Gamma钉组平均手术时间99.11min,长于动力髋螺钉组和外固定架组(P<0.05),外固定架组时间最短(P<0.05)。动力髋螺钉组出血量最多,外固定支架组最少,3组比较差异有显著性意义(P<0.05)。外固定架组的并发症发生率明显高于动力髋螺钉组和Gamma钉组。骨折愈合时间及髋关节功能优良率3组比较差异无显著性意义(P>0.05)。提示动力髋螺钉、Gamma钉及外固定架是治疗老年股骨转子间骨折的有效方法,各有优缺点,只要适应证掌握得当,根据病情合理选择固定物均能取得满意疗效。

BACKGROUND：Dynamic hip screw （DHS）,Gamma nail and external fixation frisket are widely applied to treat elderly intertrochanteric fractures,but there are no relevant criteria available in the clinical selection. OBJECTIVE：To compare the therapeutic effects of DHS,Gamma nail and external fixation frisket in treatment of elderly intertrochanteric fractures. METHODS：168 elderly patients with intertrochanteric fractures were divided into three groups,respectively treated with DHS （n=53）,Gamma nail （n=58）,and external fixation （n=57）. The operative time,blood loss,fracture healing time,and postoperative complications were compared,and joint function after operation was observed. RESULTS AND CONCLUSION：The patients were followed up for 6-35 months. The mean operative time was 99.11 minutes in Gamma nail group,significantly longer than DHS and external fixation groups （P 0.05）. The amount of blood loss in DHS group was most,followed by Gamma nail,and then external fixation group （P 0.05）. The incidence rate of complications in external fixation group was significantly greater than the other groups. There were no differences in fracture healing time or hip joint function recovery （P 0.05）. DHS,Gamma nail and external fixation are effective methods for the treatment of intertrochanteric fractures. Each method has its own advantages and disadvantages. It can achieve satisfactory results with a reasonable choice for the state of illness.