偏心固定与髓内固定治疗股骨转子间骨折的病例对照研究

Comparison of the efftec between eccentric fixation and intramedullary fixation for treatment of intertrochanteric fractures

目的 ：比较股骨转子间骨折采用偏心固定及髓内固定两种方法的疗效,为股骨转子间骨折治疗方法的选择提供理论依据。方法：2007年2月至2010年1月收治股骨转子间骨折患者82例,其中偏心固定组39例,男16例,女23例,年龄41-81岁,平均（62.68±10.69）岁,采用动力髋或股骨近端锁定钢板固定;髓内固定组43例,男15例,女28例,年龄43-78岁,平均（62.60±8.37）岁,采用PFN或PFNA固定。比较两组患者的切口长度、手术时间、术中出血量以及术后Harris评分情况。结果：两组伤口均Ⅰ期愈合,无手术并发症。82例患者均获得随访,时间12-28个月,平均18.3个月。两组切口长度、手术时间、术中出血量差异具有统计学意义。两组术后1个月Harris髋关节功能评分比较差异有统计学意义（P〈0.05）,而术后12个月Harris髋关节功能评分差异无统计学意义（P〉0.05）。偏心固定组优良率为89.7%,髓内固定组优良率为90.7%,差异无统计学意义（P〉0.05）。偏心固定组骨折不愈合1例,动力髋主钉螺丝松动并继而发生髋内翻畸形。髓内固定组无防旋钉退出,髓内钉远端股骨再骨折1例。结论：两种方法治疗股骨转子间骨折均有良好疗效,但是髓内固定较偏心固定手术时间更短,出血量更少,适用于骨质疏松和不稳定型股骨转子间骨折的治疗。

Objective：To compare the efficacy between eccentric fixation and internal fixation for treatment of intertrochanteric fractures of femur,to provide a theoretical basis for the selection of the treatment method of the intertrochanteric fractures of femur. Methods：From February 2007 to January 2010,82 patients with femoral intertrochanteric fracture were treated by internal fixation including 39 cases of eccentric fixation involving 23 males and 6 females,aged from 41 to 81 years old with an average of（62.68±10.69）,using the DHS or proximal femoral locking plate; 43 cases of intramedullary fixation involving 15 males,28 females,aged from 43 to 78 years old with an average of（62.60±8.37）,using PFN or PFNA fixed. The surgical incision length,operative time,blood loss and postoperative Harris score between two groups were compared. Results：The wound of two groups were primary healing without operative complications. All cases received follow up for an average time of 18.3 months（12 to 28 months）. The incision length,operative time and blood loss had a statistically significant difference between two groups（P〈0.05）. Harris scores of hip joint function at 1 month after operation had statistically significant difference between two groups（P〈0.05）,and Harris scores at 12 months after operation had no statistical significance difference between two groups. The rate of excellent and good was 89.7% in eccentric fixation group and 90.7% in intramedullary fixation group,the difference was not statistically significant（t=0.0613,P〉0.05）. In eccentric fixation group,there was 1 case of fracture nonunion with DHS loose and ensuing hip varus deformity. In intramedullary nail fixation group,there was no anti rotation out,distal intramedullary nail of femoral refracture occurred in 1 case. Conclusion：Two treatment methods for the treatment of femoral fractures had a good therapeutic effect,but the intramedullary fixation had shorter operative time and less blood loss than the eccentric fixation,it prior to apply to osteoporosis and unstable femoral intertrochanteric fractures.