不稳定股骨转子间骨折不同内固定方法的疗效比较

Curative effect comparison of different internal fixation methods for unstable femoral intertrochanteric fracture

目的浅析不同内固定方法对不稳定股骨转子间骨折的疗效差异。方法 2009年1月至2013年5月行内固定手术的不稳定股骨转子间骨折患者36例,采用Gamma钉固定10例为A组,动力髋螺钉(DHS)固定11例为B组,股骨近端抗旋髓内钉(PFNA)固定15例为C组。对不同的内固定方式的术中出血量、手术时间、术后并发症、骨折愈合时间及髋关节功能评分等相关数据进行统计学分析。结果各组患者术后均获随访,平均随访时间1年半,住院及随访期间无死亡病例。C组手术时间较A、B两组短,且有统计学意义(P<0.05)。B组术中出血量最多,愈合时间长,C组出血最少,但与A组比较差异无统计学意义(P>0.05)。术中A组发生股骨颈干角变小1例,髋内翻1例;B组发生髋内翻2例,头钉穿出1例,内固定松动1例;C组无相关并发症发生。骨折愈合时间A、B、C三组间比较差异无统计学意义(P>0.05)。A、C两组髋关节功能评分均较B组高,差异有统计学意义(P<0.05),但A、C两组间差异无统计学意义(P>0.05)。结论 PFNA是治疗不稳定股骨转子间骨折一个很好的选择,手术操作简便,损伤较小,出血少,固定牢靠,术后髋关节功能恢复较好,值得临床推广。

Objective To analyse the curative effect of different internal fixation methods for unstable femoral intertrochanteric fracture. Methods Altogether 36 cases with femoral intertrochanteric fracture who underwent different internal fixation methods in the hospital from January 2009 to March 2013 were recruited in the study. 10 cases of group A were fixed with Gamma nail,11 cases of group B received dynamic hip screw( DHS) fixation,and 15 cases of group C were treated with the proximal femur anti rotary intramedullary nail( PFNA).With respect to the manner of different internal fixation,intraoperative blood loss,operative time,postoperative complications,fracture healing time and the hip joint function score and related data were analysed statistically. Results All groups of patients were followed-up postoperatively,with an average time of 1 and a half years,and no deaths occurred during the follow-up. Group C had shorter operation time than group A,B with statistical significance( P < 0. 05). Group B had most bleeding amount and the healing time was long. Group C had the least bleeding,but there was no statistically significant difference compared with group A( P > 0. 05). In group A,there was 1 case of smaller femoral neck stem angler and 1 case of hip varus. In group B,hip varus occurred in 2 cases,nail wear out in 1 case,and internal fixation loosening in 1 case. In group C,there were no related complications. The difference in fracture healing time of the three groups had no statistical significance( P > 0. 05). The hip joint function score of group A,C was higher than that of group B,and the difference was statistically significant( P < 0. 05),but there was no statistically significant difference between group A and C( P > 0. 05). Conclusion PFNA treatment for unstable femoral intertrochanteric fracture is a good choice with its easy operation,less injury,less bleeding,better fixation,and better recovery of hip function,hence it is worth clinical promotion.