两种内固定方法治疗股骨粗隆下骨折的疗效分析

Efficacy analysis of two kinds of internal fixation method of treating subtrochanteric femoral fractures

目的。评价和比较应用股骨近端锁定钢板（10ckingproximalfemursplate，LPFP）和动力髋螺钉（dynamichipscrew，DHS）内固定治疗股骨粗隆下骨折临床疗效。方法2006-03—2009-12洛阳市第三人民医院骨科分别应用LPFP固定21例，DHS固定17例治疗股骨粗隆下骨折。结果36例获得随访，随访时间9～26个月，平均17．1个月，随访期内未见股骨头坏死。按RusselbTaylor分类：IA型8例，IB型16例，ⅡA型7例，ⅡB型5例。两组的术中平均出血量、手术时间、X线暴露时间、骨折临床愈合时间差异有统计学意义（P〈0．01）。但对住院时间、术后髋关节功能评定差异无统计学意义（P〉0．05）。两组在防止术后髋内翻形成差异有统计学意义（P〈0．05）。结论采用LPFP治疗股骨粗隆下骨折较传统的DHS内固定具有创伤小、出血量减少、减少术中X线暴露时间、固定可靠、有利于骨折愈合等优点，是治疗股骨粗隆下骨折较为理想的治疗方法。

Objective To evaluate and compare the clinical effects of treatment of subtrochanteric femoral fractures with locking proximal femurs plate and dynamic hip screw. Methods From Mar. 2006 to Dec. 2009, twenty one cases with subtrochanteric femoral fractures were fixed with LPFP, and seventeen cases with subtrochanteric femoral fractures were fixed with DSH. The results were obtained for 36 cases,and followed up from 9-26 months with an average of 17.1 months. FoUow-up period has not seen the avascular necrosis. According to Russell-Taylor classification,8 cases were in type I A,16 cases in type I B, 7 cases in type II A,5 cases in type II B. Results The two groups of intraoperafive average blood loss, operation time, X-ray exposure time, fracture clinical healing time have significant differences（P〈0.01 ）. But there was no significant differences（P〉0.05 ） in the length of stay and the evaluation of postoperative hip＇s function, there was significant statistically differences in preventing postoperative hip turn inward form （P〈0. 05 ）. Conclusion Compared with the fixation with DHS , the fixation of subtroehanteric femoral fractures with LPFP has small trauma,less blood loss, less radiography time, easy to operate, fixed reliable, helpful for fracture healing etc, and is an ideal method in treating subtrochanteric femoral fractures.