摘要
目的 为了解决股骨转子间骨折治疗方法多样性和繁杂性,而进行的一组生物力学对比测试及临床随访结果分析,从而寻找出一种最佳治疗方案。方法 采用经防腐处理的人离体股骨20具,制成股骨转子间骨折模型,分别用瑞士动力髋螺钉(Richards钉),单臂外固定支架,麦氏鹅头钉,单纯斯氏针固定,经纵向及偏轴加载后测出各种固定物的抗弯及抗旋转强度;同时,总结随访了1985—1998年来我院应用保守及手术治疗的转子间骨折共271例,分析治疗效果及并发症的发生率。结果 动力髋螺钉固定最稳定,承载最大,其次是支架、麦氏鹅头钉,而单纯斯氏针最差。在纵向加载(抗弯能力)中,前两组的位移最小,经统计学检验,P<0.001,在偏轴加载(抗旋转能力)中,支架及多根针明显优于单根精螺纹钉组,P<0.001;临床随访病例中,动力髋螺钉治疗优良率最高,达90％,髋内翻等并发症最少,其次是外固定支架、单纯骨牵引,斯氏针及麦氏鹅头钉,此与力学实验结果相符。结论 对于能够耐受手术的病人,应首选动力髋螺钉,因其结构牢固,具有滑动加压作用,可允许病人早期下地活动;对于不能或不愿接受手术病人,应尽可能应用单臂外固定支架固定之,以利早期下地活动,减少长期卧床的并发症,提高治疗优良率。
Objective The treatment of intertrochanteric fractures are multiple and complex. To find an optimal method, the authors had performed a series of comparative biomechanical study and analysed the results of clinical follow. Methods 20 embalmed cadaveric femoral specimens were collected and randomly allocated into four groups, each containing five femoral specimens. The intertrochanteric fractures were made. Each group was fixed with one of the four techniques. ①Dynamic Hip Screw (DHS) Made by Switzerland, ②Unilateral external fixator, ③ Nail Plate ,④three Steinmann pins. After vertical load and portrait deflective axis load test, we got the anti - rotation stiffness and antibending stiffness. From 1985 to 1998, 271 cases of intertrochanteric fractures were treated by using either operative or nonoperative method in our hospital, and we analysed the clinical effect and the incidence of complication. Results DHS is the most stable technique of all, external fixator second, and Steinmann pins is the poorest In the vertical load test (antibending ability), the displacement of the first two groups was significantly smaller than the other two groups (P <0. 001). In the deflective axis load test (anti-rotation ability), external fixator and three Steinmann pins was significantly better than groups using single thick screw (P < 0. 001) . In the cases followed, the choiceness rate of DHS was the highest (90% ), and incidence of complication was the lowest And external fixator, single bone traction, Steinmann pins, nail plate were in proper order. The clinical effect was coincident with the result of the biomechanical test Conclusion To the patients who can tolerate an operation, the authors prefer the using of DHS. For its strong design and sliding ?compression effect, it can offer early weight bearing and mobilization. To the patients who cannot or will not receive an operation, we prefer to use unilateral external fixator. For the use of it can permit early weight bearing and mobilization, and can also decrease the complication of long - term staying bed, and can improve choiceness rate of therapy.
