三种内固定方法治疗老年股骨转子间骨折的比较

目的 比较股骨近端锁定加压钢板(LPFP)、亚洲型髋关节治疗系统（亚洲型IMHS）、InterTAN治疗老年股骨转子间骨折的疗效。方法 回顾性分析2008年2月至2009年12月收治并获得随访的185例老年股骨转子间骨折患者的临床资料，分别采用LPFP(A组，95例)、亚洲型IMHS(B组，52例)、InterTAN(C组，38例)治疗；比较3组患者的手术时间、术中出血量、术中X线透视次数、住院费用、内固定失败例数及术后髋关节Harris功能评分。结果 所有患者术后获6～28个月（平均14.5个月）随访。B、C组与A组比较，手术时间短、术中出血量少、内固定失败例数少，差异均有统计学意义(P＜0.05)。B、C组比A组术中X线透视次数多、住院费用高，差异均有统计学意义(P＜0.05)。B、C两组的手术时间、术中出血量、术中X线透视次数、住院费用、内固定失败例数、Harris髋关节功能评分比较，差异均无统计学意义(P＞0.05)。B、C组与A组的Harris髋关节功能优良率比较，差异有统计学意义(P＜0.05)。结论 治疗老年股骨转子间骨折，亚洲型IMHS和InterTAN的疗效均优于LPFP，但亚洲型IMHS和InterTAN的疗效无明显差异。

A comparison of three fixations for intertrochanteric femoral fractures in the elderly

ObjectiveTo compare the efficacy of 3 internal fixations, locking proximal femoral plate (LPFP), ASIAN IMHS and InterTAN, for intertrochanteric femoral fractures in elderly patients.MethodsA retrospective study was done to analyse 185 elderly patients who had been treated for intertrochanteric femoral fractures from February 2008 to December 2009 in our hospital and fully followed up.They were treated with LPFP (group A, 95 cases), ASIAN IMHS (group B, 52 cases) and InterTAN (group C, 38 cases) . Statistical analyses were conducted to compare the 3 groups in operative time, blood loss,fluoroscopy exposure, hospital charges, intrraoperative complications and functional outcome (Harris hip score).Results The average follow-up was 14. 5 months(from 6 to 28 months). Compared with group A, groups B and C showed significant advantages in operative time, blood 1oss and functional outcome but significant disadvantages in fluoroscopy exposure and hospital charges ( P ＜ 0. 05 ). Compared with group A,groups B and C had significant fewer implant failures ( P ＜ 0. 05). There were no significant differences in all the indexes between groups B and C( P ＞ 0. 05) .Conclusions The ASIAN IMHS and InterTAN appear to be more reliable than LPFP for the treatment of intertrochanteric femoral fractures in the elderly.There appear to be no significant differences between ASIAN IMHS and InterTAN.