四种金属植入物内固定修复老年股骨转子间骨折的比较

背景：对于老年股骨转子间骨折如何选择金属植入物，应根据不同患者的年龄、骨质疏松程度、围手术期状态、骨折类型等多因素进行考虑，制定个性化的治疗方案。目的：比较4种不同金属植入物内固定修复老年股骨转子间骨折的疗效。方法：回顾2009年9月至2012年9月收治的180例老年股骨转子间骨折患者，采用4种不同金属植入物内固定进行骨折修复，动力髋螺钉组、防旋型股骨近端髓内钉组、Gamma 钉组和解剖型髋动力带锁钢板组各45例。比较各组手术时间、出血量、住院时间、内固定后Harris评分、骨折愈合时间和并发症发生情况。结果与结论：解剖型髋动力带锁钢板组和防旋型股骨近端髓内钉组手术时间、出血量及住院时间均短于动力髋螺钉组和Gamma钉组（P 〈0.05），内固定后Harris评分优良率均高于动力髋螺钉组和Gamma 钉组（P 〈0.05），而前两组间差异无显著性意义（P〉0.05）。解剖型髋动力带锁钢板组和防旋型股骨近端髓内钉组内固定后并发症发生率明显低于Gamma组和动力髋螺钉组（P〈0.05）。提示解剖型髋动力带锁钢板和防旋型股骨近端髓内钉治疗老年转子间骨折内固定可靠、内固定后并发症少，是老年股骨转子间骨折植入物内固定治疗较为理想的选择。

Comparison of four metal fixation implants for femoral intertrochanteric fractures in old patients

BACKGROUND：The selection of metal implant for old patients with femoral intertrochanteric fracture should focus on patient’s age, osteoporotic degree, perioperative status and type of fracture. Individual therapeutic program should be made. OBJECTIVE：To compare the therapeutic effects of four types of metal implant fixation for femoral intertrochanteric fracture in old patients. METHODS：180 old patients with femoral intertrochanteric fractures treated from September 2009 to September 2012 were analyzed. Four kinds of metal implants were used for repair of fracture. There were 45 patients in the dynamic hip screw group, proximal femoral nail anti-rotation group, Gamma nail group and anatomical dynamic hip lock nickelclad group, separately. Operation time, blood loss, hospital time, Harris score after operation, fracture healing time and complications in different groups were compared. RESULTS AND CONCLUSION：Operation time and hospital time were shorter, and blood loss was fewer in the＆amp;nbsp;anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the dynamic hip screw group and Gamma nail group （P〈0.05）, but the excellent and good rate of Harris score after operation was higher （P〈0.05）. No significant difference was detected between anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group （P〉0.05）. The incidence of complications was significantly lower in the anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the Gamma nail group and dynamic hip screw group （P〈0.05）. Results suggested that anatomical dynamic hip lock nickelclad and proximal femoral nail anti-rotation are reliable in treatment of intertrochanteric fracture in old patients, show less postoperative complications, and are ideal choices for implant fixation of femoral intertrochanteric fracture in old patients.