4种内固定治疗股骨转子间骨折的疗效比较

The efficacy comparison of four kinds of internal fixation methods for treatment of femoral intertrochanteric fractures

目的：探讨空心加压螺钉、动力髋螺钉（DHS）、Gamma钉、防旋股骨近端髓内钉（PFNA）4种内固定方法治疗股骨转子间骨折的临床疗效。方法对83例股骨转子间骨折患者按治疗方法分为4组：空心加压螺钉组20例，DHS组16例，Gamma钉组14例，PFNA组33例，对比4组的手术效果。结果83例均获得随访，时间7个月～4年。4组疗效比较差异无统计学意义（P＞0.05）。切口长度、手术时间、术中出血量：DHS组均长（多）于其它3组（P＜0.01），空心加压螺钉组、Gamma钉组、PFNA 组3组比较差异无统计学意义（P＞0.05）。并发症：DHS组发生率高于其它3组（P＜0.01），空心加压镙钉组、Gamma钉组、PFNA组3组比较差异无统计学意义（P＞0.05）。结论手术治疗股骨转子间骨折应根据不同的骨折类型选择合适的内固定系统。DHS术中损伤较大，PFNA固定相对较满意。

Objective To explore the clinical efficacy of four kinds of internal fixation methods cannulated compres-sion screw,dynamic hip screw（DHS）,Gamma nail,and proximal femoral anti-rotation nail（PFNA）for the treat-ment of femoral intertrochanteric fractures.Methods 83 patients of femoral intertrochanteric fractures were divided into 4 groups according to the operation method.The efficacy of operation of the 4 groups treated with cannulated compression screw（n=20）,DHS（n=16）,Gamma nail（n=14）,and PFNA（n=33）was compared.Results 83 cases were all followed up for 7~48 months.There were no statistical significant difference in the efficacy of the 4 groups（P〉0.05 ）.The length of incision,operation time,intraoperative blood loss of the group of DHS were longer or larger than the other groups（P〈0.01）.There were no statistical significant difference between the groups of can-nulated compression screw and the group of Gamma nail,and PFNA（P〉0.05 ）.DHS group had higer complication rates（P〈0.01 ）.No difference was found in cannulated compression screw,Gamma nail and PFNA groups（P〉0.05 ）.There were no statistical significant difference in the complications of the other 3 groups（P〉0.05 ）.Conclu-sions When treating femoral intertrochanteric fractures with operation,different types of fractures should use differ-ent kinds of internal fixation methods.DHS can cause more intraoperative damage;PFNA is relatively satisfactory.