PF-LCP与Gamma-3钉内固定治疗老年股骨粗隆间骨折的对比研究

A Comparative Study of Proximal Femoral Locking Compression Plate and Gamma-3 Nail in the Treatment of Femoral Intertrochanteric Fractures

目的:比较股骨近端锁定加压钢板(proximal femoral locking compression plate,PF-LCP)与Gamma3钉内固定治疗股骨粗隆间骨折的总体疗效及术后并发症。方法:对91例老年不稳定股骨粗隆间骨折,随机分组,53例采用PF-LCP内固定,38例采用Gamma3钉内固定,并对手术时间、总出血量(包括显性失血、隐性失血)、术中X线暴露次数、术后精神障碍、脂肪栓塞发生率、术后下地时间、髋关节功能进行临床随访分析。结果:PF-LCP组平均手术时间116.8min、平均总出血量为292.4mL、平均X线暴露次数6.7次、平均术后下地时间6.49周,Gamma3组平均手术时间78.2min、手术中平均出血量为171.8mL、平均X线暴露次数9.9次,平均术后下地时间4.53周。两种内固定手术方式在手术时间、手术总出血量、X线暴露次数、术后下地时间、脂肪栓塞方面比较差异均有统计学意义(均P<0.05),在术后精神障碍方面比较差异无统计学意义(P>0.05),不同骨折类型与术后髋关节功能评分相关(P<0.05)。结论:Gamma3钉创伤相对较小,操作简单,固定可靠,并发症少,有一定的优势,是治疗股骨粗隆间骨折的有效方法。

Objective：To compare the therapeutic effect on femoral intertrochanteric fracture with proximal femoral locking compression plate （LCP） and Gamma3 nail. Methods：Retrospective studied of 91 cases with femoral intertrochanteric fracture by random allocation design, 53 cases were treated with LCP internal fixation, and 38 cases with Gamma3 nail. The date of operative time, operative blood loss, x-ray expose times, mentally disturbed, fat embolism, union time, and hip function scores （Harris scores standard） were recorded. Results：The mean operative time of LCP group was 116. 8 minutes, the mean operative blood loss was 292.4 ml, the mean time of operative x-ray expose was 6.7, and the mean operative union time was 6.49 weeks. The mean operative time of Gamma3 group was 78.2 minutes, the mean total operative blood loss was 171.8 ml, the mean operative x-ray expose time was 9.9, and the mean operative union time was 4. 53 weeks. There were significant differences in operative time, operative blood loss, x-ray expose times, fat embolism between the two groups （P〈0.05）. There were no significant differences in mentally disturbed （P〈0.05）. The Harris scores were significantly relative to the types of fracture （P〈0.05）. Conclusion： The LCP and Gamma3 nail fixation are effective to treat femoral intertrochanteric fracture. But the Gamma3 nail has more advantages in reducing trauma, simplicity of operator, reliable fixation, less complications.