两种髓外内固定治疗股骨粗隆间骨折的比较研究

A comparative study of dynamic hip screw and locking comprass plate in treatment of femoral intertrochanteric fractures

[目的]比较髋动力螺钉（dynamic hip screw,DHS）和锁定接骨板（locking comprass plate,LCP）治疗股骨粗隆间骨折的疗效。[方法]对2005年3月～2008年12月本院治疗的90例股骨粗隆间骨折患者进行回顾性研究,其中46例用DHS治疗,44例用LCP治疗。记录每例患者的手术时间、术中出血量、下地行走时间、骨折愈合时间及髋关节功能评分并对相关数据进行统计学分析。[结果]术后随访6～18个月,平均12.8个月。LCP组比DHS组的手术时间短（P≈0.000 2）、术中出血量少（P≈0.000 6）、下地行走时间短（P≈0.001）,骨折愈合时间无明显差异（P≈0.082）。对于稳定性的EvansⅠ、Ⅱa型股骨粗隆间骨折,LCP、DHS的优良率并无明显差异（P≈0.064）;对于不稳定性的EvansⅡb、Ⅲ型、Ⅳ型及逆粗隆型股骨粗隆间骨折,LCP组优良率明显高于DHS组（P≈0.000 1）。[结论]两者有各自的优点和适应证,都是治疗稳定性股骨粗隆间骨折的好方法,对于不稳定性股骨粗隆间骨折LCP比DHS疗效更好,适应证更宽。

[Objective]To compare the therapeutic effect on femoral intertrochanteric fractures with dynamic hip screw（DHS） and locking comprass plate（LCP）.[Method]A retrospective study of 90 patients with femoral intertrochanteric fractures treated in of 458 hospital from March 2005 to December 2008 was carried out.46 patients were treated with DHS,and 44 with LCP.The operative time,blood loss,walking time,union time and hip function scores were recorded and statistically analyzed.[Result]All the patients were followed up for 6-18 months（mean,12.8 months in average）.Operative time in the LCP group was shorter than that of DHS group（P≈0.0002）.Blood loss in the LCP group was less than that of DHS group（P≈0.0006）.Walking time in the LCP group was shorter than that of DHS group（P≈0.001）.There was no significant difference in union time（P≈0.082）between the two groups.There was no significant difference in the excellent and good results between the two groups in stable femoral intertrochanteric fractures（P≈0.064）either.The excellent and good results of LCP group was significantly higher than DHS group in unstable femoral intertrochanteric fractures（P≈0.0001）.[Conclusion]Both technigues have their own advantages and indications.They are both effective for stable femoral intertrochanteric fractures.LCP has more advantages and indications for unstable femoral intertrochanteric fractures.