多轴锁定钢板倒置与髓内钉治疗老年股骨粗隆下骨折的疗效分析

Clinical effectiveness of reversive polyaxial locked plate and intramedullary nails for treatment of elderly femoral subtrochanteric fractures

目的分析多轴锁定钢板倒置与髓内钉治疗老年股骨粗隆下骨折的临床疗效。方法回顾性收集2009年4月至2015年4月上海交通大学附属第六人民医院骨科应用髓内钉与多轴锁定钢板倒置治疗的股骨粗隆下骨折82例,男性51例,女性31例,平均年龄为(69±10)岁。根据固定方式分为钢板组(n=40)和髓内钉组(n=42)。随访并记录患者的手术时间、C臂机透视次数、术中出血量、骨折愈合时间、并发症及术后髋关节功能评分(Harris评分)。结果 76例患者获满意随访,随访率为92.7%,随访时间为(30±9)个月。钢板组与髓内钉组的骨折愈合时间及Harris评分比较,差异无统计学意义。钢板组的手术时间[(66±11)min]、透视次数[(4.1±2.5)次],显著低于髓内钉固定组[(78±20)min、(12.1±3.2)次],差异具有统计学意义(t=3.110,t=8.452,P<0.05),而髓内钉组的术中失血量[(190±27)ml]显著低于钢板组[(446±20)ml],差异有统计学意义(t=20.348,P<0.05)。髓内钉组出现并发症较多(χ~2=7.121,P<0.05),但是两组髋关节功能评分无统计学差异。结论对于股骨粗隆下骨折,如果外侧壁完好,两种治疗方法均可达到很好的疗效。如果外侧壁冠状面破裂,尤其伴有内侧柱骨折,多轴锁定钢板倒置治疗老年股骨粗隆下骨折具有手术时间短、C臂机透视次数少的优势。

Objective To study the clinical effects of polyaxial locked plate and intramedullary nails for the treatment of elderly femoral subtrochanteric fractures.Methods All82patients with femoral subtrochanteric fractures were treated by reverse polyaxial locked plate and intramedullary nails from April2009to April2015.There were51males and31females.The average age was69±8years.Patients were divided into locking plate group(40cases)and intramedullary group(42cases).Operation time,times of X rays,total blood loss,bone healing time,complications and Harris scores were followed and compared between two groups.Results76cases were followed up for(30±9)months.There were no significant differences in bone healing time and Harris scores between two groups;the operation time(66±11min vs78±20min),times of X rays(4.1±2.5vs12.1±3.2)in locked plate group was lower than that in extramedullary group with statistical significance(t=3.110,t=8.452,P<0.05),and the blood loss(446±20ml vs190±27ml)of locked-plate group was higher than that in extramedullary group,with statistical significance(t=20.348,P<0.05).Even though the locked plate group had lower incidence of major complications(c2=7.121,P<0.05).Conclusion When the lateral wall was completed,both two kinds of internal fixations are applicable for subtrochanteric fractures.If the medial side and lateral side of the trochanter were incompleted,the polyaxial locked plate plate had the advantages of short operated time,reliable fixation and less fluoroscopy times.