【摘要】 [目的]评价第3代Gamma钉(GN)、股骨近端解剖锁定板(proximal femoral locking plate,PFLP)和动力髋螺钉(dynamic hip screw,DHS)治疗老年股骨粗隆间骨折的手术过程及疗效分析。[方法]回顾性分析2004年1月～2011年1月期间516例老年股骨粗隆间骨折患者,分别行GN(157例)、PFLP(106例)及DHS(253例)手术治疗的资料进行分析。随访时间1.2～8年,平均3.2年,男198例,女318例,年龄61～93岁,平均(76.32±5.27)岁。骨折采用Evans分型。对全部病例的切口长度、手术时间、术中出血量、术后负重时间、住院天数、骨折愈合时间及术后功能康复等情况进行比较。[结果]GN组在切口长度、手术时间、术后负重时间优于PFLP组和DHS组(P<0.05),PFLP组术中出血量少于GN组和DHS组(P<0.05),而DHS组在骨折愈合时间和术后功能评分方面明显好于GN组和PFLP组(P<0.05),在住院天数方面3组无明显差异(P>0.05),DHS组手术时间和术后负重时间好于PFLP组(P<0.05),二者在切口长度方面无显著差异(P>0.05)。[结论]GN、PFLP和DHS有各自的优点和适应证。GN对于股骨粗隆间骨折EvansⅣ型和Ⅴ型的骨折在治疗上更有价值;PFLP对股骨粗隆间骨折合并有严重骨质疏松的患者效果明显;DHS对于EvansⅠ、Ⅱ、Ⅲ型的骨折最合适。更多还原

【Abstract】 [Objective]To estimate the clinical effects of third deputy Gamma nail(GN),proximal femoral anatomic locking plate(PFLP) and dynamic hip screw(DHS) for the treatment of intertrochateric fractures in the elderly.[Method]From Jan.2004 to Jan.2011 a follow up study was done in 516 patients with intertrochateric fractures in the elderly.The patients were divided into GN(n=157),PFLP(n=106),DHS(n=253)groups.The follow-up duration were from 1.2 to 8 years with an average of 3.2 years,including 198 males and 318 females,with an average age of 76.32±5.27 years(61 to 93 years).According to Evans classification,the incision length,operative time,blood loss,walking time,union time,hospitalization time and function rehabilitation were compared.[Result]There were statistical differences in incision length,operative time,blood loss,walking time,union time and function rehabilitation among the three groups.GN group had the smallest incision length,the shortest operation time and the earlies walking among three groups(P<0.05).PFLP group had the best bleeding valum(P<0.05),DHS group had the best union time and function rehabilitation(P<0.05).[Conclusion]Each of them has its own advantage and indication.There are effective ways to treat femoral intertrochanteric fractures.GN has more advantage to the Evans Ⅳ and Ⅴ types.PFLP is especially suitable for those who are elderly and with osteoporosis.DHS indicates mostly for the EvansⅠ、Ⅱ and Ⅲ types.更多还原