三种内固定方法治疗股骨转子间骨折的临床研究

目的 比较采用动力髋螺钉（DHS）、锁定加压钢板（LCP）和Gamma 3钉治疗股骨转子间骨折（EvansⅢ型）的术中情况、术后并发症及疗效.方法 2000年2月至2008年5月,分别采用DHS（DHS组,21例）、LCP（LCP组,11例）和Gamma 3钉（Gamma 3钉组,23例）治疗并随访股骨转子间骨折（EvansⅢ型）患者55例,手术由同一组医师完成.比较3组患者手术资料、术后并发症及髋关节功能恢复情况.结果 手术时间DHS组（97.3±11.4）min;LCP组（80.4±8.2）min;Gamma 3钉组（61.4±6.7）min,两两比较均差异有统计学意义（P＜0.01）,DHS组最长,Gamma 3钉组最短.术中出血量DHS组（224.45±80.32）ml;LCP组（192.7±60.8）ml;Gamma 3钉组（103.3±41.4）ml,Gamma 3钉组少于DHS组和LCP组（P＜0.01）.Gamma 3钉组发生术后髋内翻、肢体短缩及并发症的总数（1例）少于DHS组（10例）和LCP组（4例）（P＜0.01）.DHS组、LCP组和Gamma 3钉组患肢功能按Sanders髋关节创伤评分标准,优良率DHS组84.24%;LCP组86.32%;Gamma 3钉组91.40%,组间疗效差异无统计学意义（P＞0.05）.愈合时间DHS组（8.9±7.4）个月;LCP组（8.4±7.6）个月;Gamma 3钉组（7.8±5.2）个月,组间疗效差异无统计学意义（P＞0.05）.结论 应用DHS、LCP和Gamma 3钉治疗老年股骨转子间骨折,在疗效方面无明显差异.Gamma 3钉创伤小、操作简单、手术时间短、出血量少、固定牢靠、并发症少,是治疗不稳定股骨转子间骨折的理想方法之一.

The clinical study of treatment of intertrochanteric fractures with DHS, LCP and Gamma 3 nail

Objective To compare clinical assessments including operation details, complications and functional recovery of intertrochanteric hip joint fractures treated with dynamic hip screw (DHS), locking compression plate (LCP) and Gamma 3 nail. Methods From February 2000 to May 2008, fifty-five patients with intertrochanteric fractures were included in the study. 21, 11 and 23 patients were treated by DHS, LCP and Gamma 3 nail respectively. The therapeutic effects were observed. Results There was significant difference in the mean operation time between each other among the three groups (P ＜ 0.01 ). The mean intraoperative blood loss in Gamma 3 group was statistically less than those in the other two groups (P ＜ 0.01 ). The number of patients with complications in Gamma 3 nail group was significantly lower than those in the other two groups (P ＜0.01 ). There was no significant difference in the functional recovery of hip joint between each groups ( P ＜ 0.05 ). There was no significant difference among three opetative methods as well as the therapeutic effect. Gamma 3 nail group was implanted with a significantly smaller incision and shorter operative time and clinical healing time, fewer blood loss and drainage. Gamma 3 nail group had an earlier weight bearing and a lower rate of complication. Conclusions Gamma 3 nail is one of the ideal choices for the treatment of unstable intertrochanteric fractures.