髓内钉固定治疗股骨粗隆间骨折的临床分析

Clinical Analysis of Intramedullar Nail in Intertrochanteric Fracture of Femur

目的探讨髓内固定系统治疗老年股骨粗隆间骨折的临床疗效。方法采用髓内钉固定治疗股骨粗隆间骨折261例，其中Gamina钉95例，PFN钉99例，Gamma3钉35例，PFN—A钉32例。记录手术时间、出血量（术中出血量＋术后引流量）、骨折愈合时间及内固定相关并发症。髋关节功能评定采用Harris评分。结果本组随访6～24个月，平均9个月。发生并发症14例，其中Gamma钉组8例、PFN钉组6例，Gamma3钉组和PFN-A钉组无并发症。统计学分析出血量、骨折愈合时间及髋关节功能评分，4组间差异无统计学意义（P〈0．05）。4组手术时间差异有统计学意义，其中PFN—A组手术时间最短（77．0±11．8）min，PFN组手术时间最长（82．5±10．3）min。PFN组手术时间与Gamma3、PFN—A组间差异有统计学意义（P〈O．05）。结论应用髓内固定系统治疗股骨粗隆间骨折具有良好的临床效果，应根据患者骨折类型、骨质情况选择内固定物，严格规范术中操作，避免手术并发症的发生。

Objective To discuss the application value of intramedullar nail in intertmchanteric fracture of femur. Methods Two hundred and sixty one patients with intertrochanteric fracture of femur were treated with intramedullar nail, including 95 cases by Gamma nails, 99 cases by PFN, 35 cases by Gamma3 nails, 32 cases by PFN-A. The date of each group were collected which included healing time, operation time, blood loss, complication, function of hip joint. Results All cases acquired follow- up for 6-24 months, the mean 9 months. During the follow-up period, complications occurred in 8 cases in Gamma group, 6 cases in PFN group. The difference of healing time, blood loss, function of hip joint were no statistically significant （P 〉0.05）. There was significant difference in the operative time （P 〈 0.05） compared with group Gamma, Gamma3 and PFN, PFN-A group had shorter operative time （77.0±11.8）rain. PFN group had the longest operative time （82.5±10.3）min. Conclusion Internal fixation of intramedullar nail is an easy and effective way to treat the intertrochanteric fracture of femur.