动力髋螺钉髓外固定与股骨近端髓内钉内固定治疗股骨粗隆间骨折的临床比较

目的 分析动力髋螺钉髓外固定与股骨近端髓内钉内固定治疗股骨粗隆间骨折的临床效果.方法 选取本院2014年2月至2016年2月期间收治的经确诊为股骨粗隆间骨折患者90例,均按入院顺序进行编号后以随机数表法分为髓外组(n=45)和髓内组(n=45).分别采取动力髋螺钉髓外固定术与股骨近端髓内钉内固定术治疗,观察并记录两组患者手术情况来评估术后恢复效果,指标包含手术时间、术中失血量、切口愈合时间、骨折愈合时间及下地行走时间,术后6个月采用Harris评分评估两组患者手术效果.结果 髓内组切口愈合时间略较髓外组短,两组比较差异无统计学意义(P＞0.05);髓内组手术时间为(67.47±11.18) min、下地行走时间为(6.32±1.09)周、骨折愈合时间为(8.93±2.12)周,均显著较髓外组短(均P＜ 0.05);髓内组术中失血量为(153.95±16.74)ml,显著较髓外组少(P＜0.05);髓内组术后6个月手术效果优良率为91.11％,明显高于髓外组的77.78％(P＜0.05).结论 相比于动力髋螺钉髓外固定术,股骨近端髓内钉内固定治疗股骨粗隆间骨折的临床疗效及恢复情况更满意.

Extramedullary fixation with dynamic hip screw versus internal fixation with proximal femoral nail in treatment of intertrochanteric fracture

Objective To analyze the clinical effects of extramedullary fixation with dynamic hip screw and internal fixation with proximal femoral nail in the treatment of intertrochanteric fracture.Methods Ninety patients confirmed with intertrochanteric fracture treated at our hospital from February,2014 to February,2016 were divided into an extramedullary group (n=45) and an intramedullary group (n=45) according to the admission order.The extramedullary group were treated with extramedullary fixation with dynamic hip screw and the intramedullary group internal fixation with proximal femoral nail.The state of operation in both groups was observed and recorded to evaluate the effect of postoperative recovery.The indicators included operation time,intraoperative bleeding volume,incision healing time,fracture healing time,and time of walking.6 months after operation,the Harris score was used to evaluate the operation effects in the two groups.Results The wound healing time was slightly shorter in the intramedullary group than in the extramedullary group (P ＞ 0.05).The operative time,time of walking,and fracture healing time were significantly shorter and the intraoperative bleeding volume was significantly lower in the intramedullary group (67.47±11.18) min,(6.32±1.09) weeks,and (8.93±2.12) weeks and (153.95±16.74) ml]than in the extramedullary group than that of extramedullary group (P ＜ 0.05).6 months after operation,the excellent and good rate of operation effects was significantly higher in the intramedullary group than in the extramedullary group (91.11％ vs.77.78％,P＜0.05).Conclusion Internal fixation with proximal femoral nail in treatment of intertrochanteric fracture has better clinical effect and recovery than extramedullary fixation with dynamic hip screw.