两种内固定治疗股骨转子下粉碎性骨折的临床疗效研究

Clinical efficacy of two internal fixation for the treatment of comminuted subtrochanteric fracture of the femur

目的对比interTAN钉与股骨近端锁定接骨板(PFLP)治疗股骨转子下粉碎性骨折的疗效差异。方法自2013年2月~2016年4月,我科收治的股骨转子下粉碎性骨折的患者25例。其中采用interTAN治疗15例(Seinsheimer分型Ⅱ型6例,Ⅲ型8例,Ⅴ型1例),PFLP治疗患者10例(Seinsheimer分型Ⅱ型3例,Ⅲ型3例,Ⅳ型2例,Ⅴ型2例)。记录手术时间、术中出血量、术后并发症、术后髋关节Harris评分及骨折愈合时间。结果InterTAN组和PFLP组平均手术时间分别为114min和118min;术中平均出血量分别为264mL和291mL;术后髋关节Harris评分分别为86和85分;骨折平均愈合时间分别为3.9和4.1个月。结论 InterTAN钉是治疗股骨转子下骨折的主要方式,具有良好的安全性及有效性;对于粉碎性的转子下骨折,在微创操作的基础上,股骨近端锁定接骨板是inter TAN的有效补充,可以获得与其相似的治疗效果。

Objective To compare the efficacy of interTAN nail and femoral proximal locking plate （PFLP） in the treatment of comminuted femoral subtrochanteric fractures. Methods Twenty-five patients with comminuted Femoral subtrochanteric fractures were selected in our department from February 2013 to April 2016. Among them, 15 cases were treated with interTAN （6 cases of type Seinsheimer Ⅱ, 8 cases of Ⅲ type, 1 cases of V type）, 10 cases were treated with PFLP （3 cases of Seinsheimer type Ⅱ, 3 cases of Ⅲ type, 2 cases of Ⅳ type, 2 cases of Ⅴ type）. The time of operation, the amount of bleeding, postoperative complications, Harris score of hip joint after operation and the time of fracture healing were recorded. Results The average operative time of group InterTAN and group PFLP were 114min and 118min respectively. The average bleeding volume was 264ml and 291ml respectively. The postoperative Harris score of hip joint was 86 and 85 points respectively, and the average healing time of fracture was 3.9 and 4.1 months respectively. Conclusion InterTAN nail is the main way for the treatment of femoral subtrochanteric fracture, with good safety and effectiveness; for comminuted fracture of the rotor, on the basis of minimally invasive operation, the proximal femoral locking plate is an effective supplement to interTAN, can get similar treatment effect.