股骨转子间骨折治疗方法的研究

Study of therapeutic method for intertrochanteric fracture

目的 :比较多种治疗股骨转子间骨折方法各自的优缺点及最佳适应证 ,从而找出一种最佳的治疗方案。方法 :从 1991- 2 0 0 1年共收治病例 14 0例 ,采用瑞士动力髋螺钉 (Richard钉 )、单臂外固定支架、麦氏鹅头钉、AO角度钢板内固定治疗及骨牵引保守治疗股骨转子间骨折 ,从中分析出治疗效果的优劣及并发症发生率的多少。结果 :Richard钉固定最稳定 ,承载最大 ,治疗优良率最高 ,发生的并发症最少 ;其次是外固定支架 ,角度钢板及麦氏鹅头钉。结论 :保守牵引治疗股骨转子间骨折经济、安全、简单 ,但长期卧床易导致并发症且易发生髋内翻 ,治疗优良率低。对于采用内固定治疗的患者 ,应首选动力髋螺钉。对于不能忍耐较大手术的患者 ,应尽可能应用单臂外固定支架。少数用Richard钉及多功能支架难于固定的患者 ,可采用AO角度钢板固定。而麦氏鹅头钉因其结构不够合理 ,固定强度不足 ,术后并发症多 ,应放弃使用。

Objective: To compare therapeutic methods of intertrochanteric fracture and their merits,defects and indication,in order to find out a best clinical protocol for intertrochanteric fracture. Methods: From 1991 to 2001,140 cases of intertrochanteric fracture were treated with Richard nail,lateral external fixation,goose-head shape nail,AO angle steel plate and skeletal traction;effect and incidence of complication in the therapeutic methods were analyzed respectively. Results: Richard nail was the most stable,with maximum bear weight,highest good therapeutic efficacy rate and least complication incidence.The second was lateral external fixation and then AO angle steel plate and goose-head shape nail with the poorest therapeutic efficacy. Conclusion: According to our study,conservative traction therapy is an economic,safe and simple method for the treatment of intertrochanteric fracture.However,long-term bed cause more complication and coax-inversion,with poor therapeutic efficacy.The internal fixation,Richard nail will be the first choice for those patients.The lateral external fixation should be used as long as possible for the patients who cannot tolerate a big operation.While AO angle steel plate can also be used for those difficult to be fixed by Richard nail or lateral external fixation.Goose-head shape nail should be given up to use since its irrational structure and insufficient fixation strength but high complication.