微创Gamma钉与DHS治疗老年股骨转子间骨折的比较

Comparison of Mini-invasive Methods with Gamma nail and DHS in Treating Femoral Intertrochanteric Fracture of Senile Patients

目的：比较微创Gamma钉与动力髋螺钉（Dynamic Hip Screw,DHS）治疗老年股骨转子间骨折的疗效.方法：选择我科在2004-2009年期间进行了手术治疗的老年股骨转子间骨折患者60例,其中采用Gamma钉与DHS固定各30例.对手术切口大小、手术时间、术中出血量、术后引流量、骨折愈合情况、术后并发症及Harris 髋关节评分等指标进行分析.结果：两组切口长度、术中出血量均具有显著性差异（P〈0.05）,Gamma钉组较DHS组小,而术后引流量、手术时间、骨折愈合时间、Harris评分,Gamma钉组与DHS组比较差异无显著性（P〉0.05）.Gamma钉内固定治疗组中出现1例伤口感染、1例脂肪栓塞,DHS组中出现2例伤口感染,两组均未出现内固定物切出股骨头或断裂等现象.结论：应用Gamma钉、DHS治疗老年股骨转子间骨折,在疗效方面无明显差异,只要严格掌握适应证,合理选择内固定,手术操作规范,均可以获得良好的临床效果.

Objective To observe the clinical results of Gamma nail in comparison with Dynamic Hip Screw. Methods We collected the clinical data of 60 old patients with intertrechanterie fracture from 2004 to 2009. Of them, 30 cases were fixed with Gamma nail and the rest with DHS. We analyzed and compared these cases with respect to invasive size, operation time, amount of blood loss, healing time of fracture, Harris hip joint score and the incidence of complication. Results In the 2 groups , averse invaslve size and amount of blood loss were statistically different（ P 〈 0.05 ）. Gamma nail cases was less than the DHS ones in these two items. However, there was no significant difference between Gamma nails and DHS in operation time, healing time of fracture, and Harris score （P 〉 0.05 ）. In all cases, no complication of internal fixation was observed, in spite of I case with wound infection in Gamma nail group and 2 cases in DHS groups . Conclusion Gamma hall and DHS were both effective in surgical treatment of intertrochanteric fractures, provided strict indication and excellent manipulation.