动力髋螺钉与Gamma钉治疗高龄股骨转子间骨折

目的对比观察动力髋螺钉、G amm a钉治疗高龄患者股骨转子间骨折的临床疗效。方法选择2008年5月至2009年5月我院骨科收治的股骨转子间骨折患者60例,男38例,女22例;平均年龄（75±3.7）岁。根据T ron-zo-Evans分型系统,60例患者按入院顺序交替分为动力髋螺钉内固定治疗组30例及G amm a钉内固定治疗组30例。记录术中出血量、手术时间,观察骨折愈合情况,术后12个月采用H arris评分标准对患髋功能进行评估。结果所有患者均获得随访。a）G amm a钉内固定治疗组术中出血量、手术时间均少于动力髋螺钉内固定治疗组（P〈0.05）;b）动力髋螺钉内固定治疗组并发髋内翻2例,伤肢短缩1例。G amm a钉内固定治疗组未出现内固定物切出股骨头或断裂等内固定失效现象。c）髋关节H arris功能评分显示,动力髋螺钉内固定治疗组优2 2例,良5例,可3例,优良率90.0%;G amm a钉内固定治疗组优23例,良5例,可2例,优良率93.3%。两组间差异无显著性意义（P〉0.05）。结论应用动力髋螺钉、G amm a钉治疗老年股骨转子间骨折,在疗效方面无明显差异。G amm a钉可缩短手术时间、减少术中出血量及术后并发症。对于稳定性骨折,两种内固定装置均可选择;对于不稳定性骨折,G amm a钉有生物力学上的优势。

Clinical Research on Dynamic Hip Screw and Gamma Nail in Treating Intertrochanteric Fractures in the Elderly

Objective To evaluate and compare the clinical curative effect of dynamic hip screw and Gamma nail in the treatment of intertrochanteric fractures in the elderly.Methods A total of 60 cases of intertrochanteric fracture,38 males,22 females,aged 70~88 years,were selected from Department of Orthopaedics,,yangchun people′s hospital between may 2008 and may 2009.According toTronzo-Evans classification system,the patients were divided into 2 groups：DHS（n=30）,Gamma nail（n=30）.operative blood loss,surgery duration,postoperative complications,fracture healing,were recorded.The hip evaluation was evaluated 12 months after surgery using Harris scores system.Results All patients were followed-up.a）The blood loss and surgery duration of Gamma nail group was significantly less than DHS group（P〈0.05）;b）two case of DHS group developed coax vara,and one developed injured extremity crispation.No complications were found in Gamma nail group,all fracture healed at the primary stage.Fixation failure such as fixator cutting-out of femoral head or breakage was not found in any case.c）Harris scores for hip joint showed that there were 22 cases excellent,5 good,and 3 fine in DHS group,with excellent and good rate of 90.0%;23 excellent,5 good,and 2fine in GN group,with excellent and good rate of 93.3%;There were no significant differences（P〉0.05）.Conclusion Application of DHS and Gamma nail in treatment of intertrochanteric fractures in elderly showed no significant difference in efficacy.Gamma nail can shorten the operation time to reduce the blood loss and postoperative complications.For the stable fracture,two fixtures can be used,While for instable fracture,Gamma nai will be good choices.ldue to the biomechanical advantages.