难复位型与易复位型股骨转子间骨折治疗的对比分析

The treatment of hard reduction intertrochanteric fracture

目的探讨应用股骨近端髓内钉治疗难复位型股骨转子间骨折的手术效果。方法回顾性分析2008年10月至2013年9月采用股骨近端髓内钉治疗、并获得1年以上随访的315例老年转子间骨折患者的资料。其中57例出现常规闭合复位难以纠正的骨折远折端严重后倾,远近骨折端接触<骨干直径的60%,将其作为难复位组;其余患者作为易复位组。对两组的手术时间、术中出血量、输血病例数、术中骨折复位程度、住院时间、影像学骨折愈合时间以及术后1年Harris评分进行统计分析。结果两组患者住院时间、影像学骨折愈合时间差异无统计学意义;而手术时间、术中出血量、输血病例数、术中骨折复位程度以及Harris评分,难复位组分别为(146.4±21.4)min、(337.5±49.3)ml、49例、72.3%、(72.4±4.4)分;易复位组分别为(86.7±15.2)min、(130.4±33.4)ml、43例、93.4%、(81.5±5.4)分,两组比较差异有统计学意义(P<0.05)。结论难复位型股骨转子间骨折治疗过程相对复杂,疗效水平略低于易复位组。

Objective To discuss the effect of hard reduction inter-trochanteric fracture treated with proximal femoral intramedullary nail. Methods Three hundred and fifteen cases were treated with proximal femoral intramedullary nail between October 2008 and September 2013, and followed up for over one year. Because of backward of distal part, 57 patients was defined as hard reduction group, whose distal contact was lower 60% of diameter of shaft of femur. Others were easy reduction group. The operation time, intra- operative blood loss, volume of blood transfusion, degree of reduction,hospital stay, radiographic fracture healing time and 1 year Harris score were compared. Results Hospital stay and radiographic fracture healing time did not have significant differences between the two groups. The operation time, intraoperative blood loss, volume of blood transfusion, degree of reduction, Harris score in hard reduction group were（146.4±21.4）min,（337.5 ± 49.3）ml, 49 cases, 72.3%, 72.4 ± 4.4, respectively; which were（86.7 ± 15.2）min,（130.4 ± 33.4）ml, 43 case,93.4%, 81.5±5.4 in easy reduction group, respectively. The difference between the two groups was significantly different.Conclusion Hard reduction intertrochanteric fracture is difficult to treat, and the curative effect is worse than the easy reduction group.