外侧壁厚度对动力髋螺钉治疗外侧壁完整的股骨粗隆间骨折临床疗效的影响

Influence of lateral wall thickness on clinical effect of dynamic hip screw in treating complete lateral wall femoral intertrochanteric fracture

目的探讨外侧壁完整的股骨粗隆间骨折患者经动力髋螺钉(DHS)治疗时外侧壁厚度对临床疗效的影响。方法选取该院2014年12月至2015年12月收治的股骨粗隆间骨折患者90例,按gotfried分型分为外侧壁稳定组(43例)和外侧壁危险组(47例)。外侧壁稳定组患者中骨折分型为A1型26例,A2.1型17例;外侧壁危险组患者中骨折分型为A2.2型24例,A2.3型23例。两组患者均接受DHS内固定手术治疗,记录其手术情况(手术时间、术中出血量和术后住院时间)及疗效。术后随访1年。结果外侧壁稳定组患者手术时间、术中出血量、术后住院时间均明显少于外侧壁危险组,两组患者术后1年Harris髋关节功能评分量表评分均明显高于治疗前,外侧壁稳定组患者髋关节功能改善效果更优,差异均有统计学意义(P<0.05)。结论外侧壁厚度直接影响股骨粗隆间骨折患者接受DHS治疗的疗效,医生如何根据患者实际情况合理选择治疗方案将直接影响疗效与患者康复结果。

Objective To investigate the effect of lateral wall thickness on clinical effect in the patients with complete lateral wall femoral intertrochanteric fracture treated with dynamic hip screw （DHS）. Methods Ninety patients with intertro- chanteric fractures in our hospital from December 2014 to December 2015 were selected and divided into the lateral wall stable group （43 cases） and lateral wall risk group （47 cases） according to Gotfried classification. In the lateral wall stable group, 26 cas- es were the type A1 and 17 cases were type A2.1. In the lateral wall risk group, 24 cases were type A2.2 and 23 cases were type A2.3. The two groups received DHS internal fixation operation treatment. Then the operation situation （operation time, intraopera- rive bleeding amount and postoperative hospitalization time） and curative effects were recorded. The postoperative follow up lasted for 1 year. Results The operation time, intraoperative bleeding volume and postoperative hospitalization time in the lateral wall stable group were significantly less than those in the lateral wall risk group, the Harris hip joint function score at postoperative 1 year in the two groups were significantly higher than that before treatment, the hip joint function improvement effect in the lateral wall stable group was excellent,the difference was statistically meaning（P〈0.05 ）. Conclusion The lateral wall thickness directly affects the efficacy of DHS treatment in the patients with intertrochanteric fracture,and how the doctor choosing the treatment scheme according to the patient＇ s actual situation will directly affect the curative effect and patient＇s rehabilitation result.