两种内固定方式在股骨转子下长段粉碎性骨折治疗中的应用

Two internal fixation methods in treatment of subtrochanteric low long segment comminuted fractures

目的探讨股骨近端解剖型锁定加压钢板和防旋型股骨近端髓内钉治疗股骨转子下长段粉碎性骨折优缺点和术后疗效。方法 40例股骨转子下长段粉碎性骨折患者按入院时间列序编号,20例(单号)使用股骨近端解剖型锁定加压钢板(LCP组),另20例(双号)使用防旋型股骨近端髓内钉(PFNA组);术后观察两组患者伤口愈合情况、扶杖下床时间、骨折愈合时间及骨不连情况等,分别使用Harris评分和Lyshonlm评分评价髋、膝关节恢复情况。结果全部40例病例12个月内定期随访。两组患者均未发生患肢深静脉栓塞和内固定断裂。LCP组扶杖下床时间短于PFNA组,差异具有统计学意义(P<0.05);骨折愈合时间长于PFNA组,差异具有统计学意义(P<0.05)。LCP组术后2周～12个月Harris评分均低于PFNA组,差异具有统计学意义(P<0.05);术后2～12个月Lyshonlm评分高于PFNA组,差异具有统计学意义(P<0.05)。结论如果没有合并有骨质疏松及股骨髓腔狭窄的患者,建议使用加长型PFNA,术中尽量对骨折端闭合复位并闭合穿钉固定;对于骨折端过于粉碎,病理性骨折以及合并有骨质疏松的患者,建议使用LCP内固定。

Objective To investigate advantages, disadvantages and postoperative outcomes of treating subtrochanteric low long segment comminuted fractures with proximal femur locking compression plate and proximal femoral intramedullary nail antirotation blade. Methods All the 40 patients with subtrochanteric low long segment comminuted fractures selected in accordennce with the admission time and sequent numbers were edited. Twenty patients with single number adopted proximal femur locking compression plate （LCP group ）, and 20 patients with double number adopted proximal femoral intramedullary nail antirotation blade （PFNA group）. Wound healing, time for patients to get out of bed, fracture healing time, nonunion and so on were observed after operation in the two groups. Harris scores and Lyshonlm scores were used to evaluate recovery of hip and knee. Results Each patient was followed up within 12 months at regular intervals. All patients in the two groups did not have internal fixation fractures and limb deep vein thrombosis. Time for patients of LCP group to get out of bed was shorter than that of PFNA group, but fracture healing time of LCP group was longer than that of PFNA group, comparison of them was statistically significant （ P 〈 0. 05 ）. Harris scores of LCP group were all lower than those of PFNA group, but Lyshonlm scores of LCP group were all higher than those of PFNA group from two months to twelve months after operations, comparison of them was statistically significant （ P 〈 0.05 ）. Conclusions It is recommended to use the stretched PFNA for the patients without combination of osteoporosis and femoral canal stenosis. The closed reduction and closed nailed fixation should be adopted on the fracture end as far as possible during operation. LCP internal fixation is recommended for the patients with excessive crushing on the end with fracture, patients with pathological fractures, or patients with osteoporosis.