股骨转子间骨折3种内固定方法的疗效比较

Clinical analysis of three internal fixation methods on femoral intertrochanteric hip fractures

目的探讨不同内固定治疗股骨转子间骨折的临床疗效。方法 97例股骨转子间骨折患者按治疗方法分为3组:动力髋螺钉固定组(A组)37例,解剖锁定钢板固定组(B组)36例,Gamma钉固定组(C组)24例。分析各种方法的疗效及优缺点。结果手术时间:A组为(102±19)min,B组为(75±15)min,C组为(71±11)min;A组与B、C组比较差异均有统计学意义(P<0.01),B组与C组比较差异无统计学意义(P>0.05)。出血量:A组为(501±134)ml,B组为(212±38)ml,C组为(198±31)ml;A组与B、C组比较差异均有统计学意义(P<0.01),B组与C组比较差异无统计学意义(P>0.05)。术中X线暴露次数:A组为(7±3)次,B组为(8±3)次,C组为(8±2)次;3组间两两比较差异无统计学意义(P>0.05)。术后髋关节功能Harris评分优良率:A组83.78%,B组88.88%,C组87.50%。结论 Gamma钉具有手术耗时少、术中X线透视时间短、创伤小、术后内固定稳定性强、并发症少、骨折愈合快、患肢功能恢复快等优点,可以作为治疗股骨转子间骨折优选内固定方法;解剖锁定钢板结合微创技术治疗股骨转子间骨折也有较大的适用范围;动力髋螺钉操作简单,适宜应用于无严重骨质疏松的A1型和A2转子间骨折。

Objective To investigate the effect of internal fixation methods in the femoral intertrochanteric fracture. Methods 97 cases of intertrochanteric hip fractures, by compairing the treatment methods, were divided into three groups： the dynamic hip screw （DHS） fixation group （group A） in 37 cases, the locking anatomical plate fixation group （LCP） （group B） in 36 cases, Gamma intramedullary nail group （group C） in 24 cases. The effects of various kinds of methods were analysed. Results Operation time of group A was （ 102± 19） min, group B was （75 ± 15 ） min, group C was （71± 11 ） min. There was statistically significant difference between group A and group B, C（ P 〈 0. 01 ）. There was no statistical difference between group B and C （ P 〉 0. 05 ）. The amount of bleeding in group A was （501 ±134） ml, group B： （212 ±38） ml,group C： （198 ±31） ml;There was statistically significant difference be- tween group A and group B ,C （P 〈 0.01 ）. There was no statistical difference between group B and C （P 〉 0.05 ）. The X-radiographic exposure times of group A were （7 ~ 3 ） times ; group B were （ 8 ± 3 ） times; group C were （ 8 ：t： 2） times. Multiple comparison of the three groups of X-radiographic exposure times, there was no statistically significant difference （P 〉 0. 05）. Hip joint function according to Harris score after operation, excellent and good rate was 83.78% in group A, 88. 88% in group B,87. 50% in group C. Conclusions Gamma nail has advantages in the treatment of femoral intertrochanteric fractures： Operation time is short, intraoperative fluoroscopy times is less, trau- ma is little, postoperative stability of fixation is strong, complications is fewer, fracture healing is faster, recovery of limb function is quicker, etc. And it can be used as the preferrd internal fixation treatment for femoral intertrochan- teric fractures. LCP combined with the minimally skill treatment also has a good range of application the treatment of femoral intertrochanteric fractures. DHS operation is simple, and is appropriate to the treatment of femoral intertrochant fracture of type A1 and A2 without severe osteoporosis.