解剖型锁定钢板与股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的58例临床疗效观察

Clinical Observation of Anatomical Proximal Femoral Locking Plate and Anti- rotation Intramedullary Nail in the Treatment of Intertrochanteric Fractures

目的 评价解剖型锁定钢板与股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的临床疗效,探讨其临床适用性.方法 选择从2010年3月～2012年8月于笔者医院就诊的58例股骨粗隆间骨折患者,分为髓内钉组30例和锁定钢板组28例,锁定钢板组采用解剖型锁定钢板固定治疗,髓内钉组则采用股骨近端防旋髓内钉内固定治疗.观察两组患者手术前后的一般情况,术后并发症发生情况、骨折愈合和关节功能评分情况.结果 锁定钢板组患者的手术切口长度、手术时间、术中出血量、术后引流量、术后下地时间、术后平均住院时间、患肢完全负重时间和骨折愈合时间均显著长于髓内钉组（P＜0.05）.术后并发症发生率髓内钉组为3.33％,锁定钢板组为25.00％,锁定钢板组高于髓内钉组（x2=4.04,P＜0.05）.术后关节功能改善率髓内钉组为86.7％,锁定钢板组为64.3％,髓内钉组优于锁定钢板组（x2=4.45,P＜0.05）.结论 股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折疗效优于解剖型锁定钢板.

Objective To study the efficacy of anatomical proximal femoral locking plate and anti-rotation intramedullary nail in the treatment of intertrochanteric fractures.Methods Fiyty eight cases of intertrochanteric fracture patients were selected from March 2010 to August 2012 in our hospital.The patients were divided into intramedullary nail group （n =28） and locking plate group（n =30）.The control group were treated with anatomic locking plate,while the anti-rotation experimental group used intramedullary nail.The occurrence of postoperative complications,fracture healing and joint function score was compared.Results The incision length,operative time,blood loss,postoperative drainage,postoperative ambulation time,mean postoperative hospital time,weight bearing time and healing time in intramedullary nail group were less than that in locking plate group （P ＜ 0.05）.Rate of postoperative complicationsin in intramedullary nail group was 3.33％,which was lower than that of 25.00％ in locking plate group （x2 =4.04,P ＜ 0.05）.Rate of postoperative joint function improvement was 86.7％ in intramedullary nail group,which was better than that of 64.3％ in locking plate group （x2 =2.45,P ＞ 0.05）.Conclusion Anti-rotation intramedullary nail fixation was more effective than anatomic locking plate in the treatment of intertrochanteric fractures.