两种头髓型内固定系统治疗不稳定型股骨粗隆间骨折的回顾性分析

Retrospective analysis of two kinds of cephlar-medullary internal fixation in treating unstable intertrochanteric fracture

目的回顾性分析AsianIMHS和INTERTAN治疗不稳定型股骨粗隆间骨折的临床疗效。方法2009年9月-2011年9月，我院手术治疗不稳定型股骨粗隆问骨折共105例，其中IMHS组58例，INTERTAN组47例。按EVANS分型，Ⅰc型51例，Ⅰd型35例，Ⅱ型19例。记录手术时间、出血量，采用Harris评分进行髋关节功能评定。结果INTERTAN组手术时间平均58±7．5分钟；术中出血量平均180±50ml；未发生头钉切出等并发症。IMHS组手术时间平均65±15分钟，出血量平均171±45ml，有2例发生拉力螺钉退出合并感染，3例发生股骨头颈旋转，2例发生髋内翻。对上述两组的出血量、手术时间应用独立样本t检验进行对比，P〉0．05，结果无显著性差异。对Harris评分进行χ2检验，P〈0．05，统计学上有显著性差异。结论与AsianIMHS相比，INTERTAN具有固定更牢靠、加压确实、防旋抗切出等诸多优点，早期并发症少，是治疗不稳定型股骨粗隆间骨折的一种很好的内固定方式，尤其适用于骨质疏松性粉碎性骨折。

Objective Retrospective analysis the clinical outcome in treating unstable intertrochanteric fracture with Asian IMHS and INTERTAN. Methods 105 cases of unstable intertrochateric fracture were operatived from September 2009 to September 2011, among them, 58 cases fixed with Asian IMHS and 47 cases fixed with INTERTAN. According to EVANS classification, type Ⅰc 51 cases, Ⅰd 35cases, Ⅱ 19cases. Operative time and blood loss were documented. Harris score were used to evaluate the hip function. Results Operating time of 1NTERTAN group was 58 _ 7.5 minutes, and blood loss was 180 _ 50ml. Complications including cut out did not take place. In IMHS group, Operating time was 65 ± 15 minutes, and blood loss was 171 ±45ml, quit of the lag screw combined with infection happened in 2 cases, rotation of femoral head and neck in 3 cases, varus malposition in 2 cases. Two-sample t test was used, and P〉0.05, there were not significant differences in the operating time and blood loss between the two groups. Chi-square test was used to the Harris score, and P〈0.05, there were significant differences between the two groups. Conclusion Compared with the Asian IMHS, INTERTAN could afford more stable and compress more certainty and anti-rotation and anti-cut out, and less early complications took place, so it is a good method in treating unstable intertrochateric fracture, especially fitted in those osteoporosis and comminuted fractures.