锁定钢板与动力髋螺钉治疗股骨粗隆间骨折的临床对照试验

Case-control studies on locking plates and dynamic hip screw in treatment of intertrochanteric hip fractures

目的:探讨锁定钢板治疗股骨粗隆间骨折的临床疗效。方法:回顾性分析2006年2月至2008年12月收治的108例股骨粗隆间骨折患者的临床资料。采用股骨近端锁定钢板治疗股骨粗隆间骨折51例,男23例,女28例;年龄45～86岁,平均66.0岁;采用DHS治疗股骨粗隆间骨折57例,男26例,女31例,年龄43～81岁,平均64.1岁。观察手术时间、术中出血量、术后引流量、骨折临床愈合时间、术后并发症及术后髋关节功能恢复情况。术后髋关节功能按Harris评分评定。结果:108例均获随访,时间8～24个月,平均12.5个月。锁定钢板组手术时间平均(87±14)min,术中出血量平均(367±213)ml,术后引流量平均(63±14)ml,骨折临床愈合时间平均(11.9±3.4)周,术后并发症7例,Har-ris评分平均(85±6)分;DHS组手术时间(115±23)min,术中出血量平均(582±243)ml,术后引流量平均(98±16)ml,骨折临床愈合时间平均(12.4±2.5)周,术后并发症9例,Harris评分平均(84±8)分。两组骨折愈合时间、术后并发症及髋关节功能恢复情况差异无统计学意义(P>0.05),手术时间、术中出血量及术后引流量差异有统计学意义(P<0.05)。与DHS组相比,股骨近端锁定钢板组手术时间短、术中出血量及术后引流量少。结论:股骨近端锁定钢板操作简单、创伤小、固定牢靠、并发症少,是治疗股骨粗隆间骨折的有效方法。

Objective：To explore the clinical effects of locking plates in the treatment of intertrochanteric hip fractures.Methods：From February 2006 to December 2008,108 patients with intertrochanteric hip fractures treated with locking plate and DHS were retrospective analyzed.Fifty-one patients were treated with locking plates,including 23 males and 28 females,aged 45 to 86 years old（averaged 66.0 years old）;and fifty-seven patients were treated with DHS,including 26 males and 31 females,aged 43 to 81 years old（averaged 64.1 years old）.The outcome measures collected for statistical analysis on the following aspects：operative time,blood loss,drainage,healing time,complications and Harris scores.Results：One hundred and eight patients were followed up ranging from 8 to 24 months（averaged 12.5 months）.In locking plate group,the operative time was （87±14） minutes;blood loss was （367±213） ml;drainage was （63±14） ml;healing time was（11.9±3.4） weeks;7 patients had complications;and the Harriss score was（85±6）.While in DHS group,the operative time was（115±23） minutes;blood loss was（582±243） ml;drainage was （98±16） ml;healing time was （12.4±2.5） weeks;9 patients had complications;and the Harriss score was（84±8）.There were no significant differences in the healing time,complications and Harris scores between two groups （P0.05）,but there were significant differences in the operative time,blood loss,drainage between two groups（P0.05）.Comparing with DHS group,the locking plate group was of shorter operative time,fewer blood loss and drainage.Conclusion：Proximal femoral locking plate is simple,minimally invasive,stable fixation with fewer complications,and is an effective method for intertrochanteric hip fractures.