【摘要】 目的比较4种不稳定股骨转子间骨折内固定方法的疗效。方法2000年1月~2004年12月,不稳定股骨转子间骨折内固定并获随访1年以上患者88例,男52例,女36例。年龄19~86岁。受伤至手术时间2~9d。致伤原因:高处坠落伤22例,交通事故伤36例,摔伤20例,跌伤10例。分别采用动力髋(dynamichipscrew,DHS)固定42例(A组);解剖钢板固定23例(B组);股骨近端交锁钉(proximalfemoralnail,PFN)固定8例(C组);动力髁螺钉(dynamiccondylarscrew,DCS)固定15例(D组)。按照改良Evan’s分类均为不稳定性骨折;其中A组、、型分别为15、8、19例,B组分别为12、5、6例,C组分别为3、2、3例,D组分别为10、3、2例。记录患者的手术时间、术中出血量、术中X线暴露次数及术后并发症、骨折临床愈合时间,术后髋关节功能评分等相关数据,进行统计学处理。结果术后患者均获随访12~48个月,平均18个月。各组骨折术后3~5个月均获临床愈合。住院期间无死亡,随访6个月死亡5例,均死于心脑血管疾病。术后A组3例,C组1例,D组3例并发髋内翻。各组手术时间,术中并发症比较,差异无统计学意义(P>0.05)。A组术中出血量最多,B组最少,与C、D组比较,差异均有统计学意义(P<0.05);C、D组间比较,差异无统计学意义(P>0.05)。B组术中X线暴露次数最少、临床愈合时间较长、无术后并发症,与其余各组比较,差异有统计学意义(P<0.05)。D组术后功能评分最低,与其余各组比较,差异有统计学意义(P<0.05)。结论解剖钢板对于不稳定股骨转子间骨折是一种行之有效的较好方法,手术操作相对简便,术后髋关节功能恢复较好。更多还原

【Abstract】 Objective To explore the effects of various kinds of internal fixations on unstable intertrochanteric femoral fractures. Methods From January 2000 to December 2004,88 cases of unstable intertrochanteric femoral fractures were treated. There were 52 males and 36 females (aged 19-86 years). Twenty-two cases were caused by fall from height, 36 by motor vehicle accident and 20 by fall and 10 by tumble. They were divided into 4 groups according to 4 kinds of internal fixations: dynamic hip screw(DHS,group A, n=42), anatomical proximal femur bone plate (group B, n=23), proximal femoral nail(PFN,group C, n=8)and dynamic condylar screw (DCS, group D, n=15). According to the modified Evan’s classification, fractures were all unstable type and were classified as follow types: group A (15 type Ⅲ, 8 type Ⅳ and 19 type Ⅴ); group B (12 type Ⅲ, 5 type Ⅳ and 6 type Ⅴ); group C (3 type Ⅲ,2 type Ⅳ and 3 type Ⅴ); and group D (10 type Ⅲ,3 type Ⅳ and 2 type Ⅴ). The data of operative time, intra-operative blood loss, intra-operative complications, fluoroscopy exposures, clinical healing time of fracture, post-operative restored function and postoperative complications were recorded and analyzed statistically using the SPSS 12.0 software package. Results All patients were followed up for 12-48 month (18 months on average). All patients achieved clinical healing. Coxa varus occurred in 3 cases of group A, in 1 case of group C and in 3 cases of group D . The differences were of no statistical significance in operative time and postoperative complications between 4 groups (P>0.05). The difference was of statistical significance in the blood loss between groups A,B and groups C,D (P<0.05) but no statistical significance between group C and group D (P>0.05). The difference was of statistical significance in the fluoroscopy exposures, clinical healing time of fracture and postoperative complications between group B and the other groups (P<0.05). The difference was of statistical significance in the post-operative restored functions between group D and the other groups (P<0.05). Conclusion The anatomical proximal femur bone plate is a useful device in the treatment of unstable intertrochanteric femoral fracture. The operative manipulation is simple and the hip functions recover well.更多还原