Gamma钉、动力髋螺钉、解剖形钢板3种固定物治疗老年股骨粗隆间骨折疗效分析

Elderly femoral intertrochanteric fractures treatment using Gamma nail,dynamic hip screw and anatomical plate

目的:比较Gamma钉、动力髋螺钉、解剖形钢板3种固定物治疗老年股骨粗隆间骨折的临床疗效,为临床选择适当的治疗方法提供依据。方法:选取103例股骨粗隆间骨折患者,其中Gamma钉内固定21例、动力髋螺钉内固定47例、解剖形钢板内固定35例,回顾性分析三组手术时间、切口长度、术中出血量、术后引流量、愈合时间、术后并发症、负重时间、平均住院日、住院费用及髋关节功能恢复情况。结果:术后随访6～30月。三组术后引流量差异无显著意义(P>0.05),解剖钢板组手术时间最短,差异有显著性意义(P<0.01),Gamma组手术时间短、术中出血量最少,切口长度最短及解剖钢板组出血量少,差异有显著性意义(P<0.05),DHS组手术时间最长,出血量最多。三组间并发症发生率、骨折愈合时间、住院时间比较,差异无显著性意义(P>0.05)。Gamma钉组负重时间最短,差异有显著性意义(P<0.05)。DHS组和解剖钢板组负重时间比较,差异无显著性意义(P>0.05)。DHS组、解剖钢板组比Gamma钉组住院费用低,比较差异有显著性意义(P<0.05)。三组髋关节Harris功能评分的优良率分别为90.47%、85.10%和85.71%,Gamma组优良率最高,但差异无显著性意义(P>0.05)。结论:Gamma钉、动力髋螺钉、解剖形钢板是治疗股骨粗隆间骨折的有效方法,各有优缺点,根据病情、严格掌握适应症来选择合适的内固定物均能取得较好的疗效。

Objective：To compare the therapeutic effects of Gamma nail,dynamic hip screw and anatomic plate in treatment of elderly femoral intertrochanteric fractures,and make theoretical analysis to offer basis on choosing the proper treatment method in clinic.Methods：We retrospectively reviewed the clinical and radiological records of 103 patients with femoral intertrochantefic fracture for three kinds of different treatment：internal fixation of Gamma nail（n=21）,dynamic hip screw（DHS）（n=47） and anatomical plate（n=35）,The operative time,the length of incision,blood loss,wound rainage,fracture healing time,walking time,the average hospitalization days,cost of hospitalization,and postoperative complications were compared,and joint function after operation was observed.Results： The patients were followed up for 6-30 months.The wound drainage,fracture healing time,the average hospitalization days,postoperative complications was similar in three groups（P〉0.05）.The mean operation time in anatomic plate group was significantly lower than Gamma nail,dynamic hip screw groups（P〈0.01）.The mean operative time in internal fixation of Gamma nail group was lower than DHS group（P〈0 05）.The length of incision and blood loss in internal fixation of Gamma nail group were significantly lower than the control group（P〈0 05）.The mean operation time in Gamma nail group was lower than dynamic hip screw groups（P〈0.05）.The blood loss in anatomic plate group was lower than DHS group（P〈0 05）.The mean operation time and blood loss in DHS group were significantly higher than the control group.The walking time in internal fixation of Gamma nail group was significantly shorter than the control groups（P〈0 05）,while,it was similar in DHS and anatomic plate groups（P〉0.05）.Cost of hospitalization in dynamic hip screw and anatomic plate were lower than Gamma nail group（P〈0 05）.Harris scores for hip joint showed that there were excellent and good rate of 90.47% in Gamma nail group,with excellent and good rate of 85.10% in DHS group,with excellent and good rate of 85.71% in Gamma nail group.There were no significant differences（P〉0.05）.Conclusions： Gamma nail,DHS and anatomic plate are effective methods for the treatment of femoral intertrochanteric fractures.Each fixture has its own advantages and disadvantages.It can achieve better results with a reasonable choice for the state of illness.