股骨粗隆间骨折分型与内固定方法的选择

目的根据股骨粗隆间骨折的诊治进展,进一步研究其分型并指导临床术式的选择,以提高手术疗效。方法笔者自2004年1月～2006年1月对80例股骨粗隆间骨折手术依其骨折类型和全身状况施行外固定架、钢板、动力髋螺钉(DHS),或股骨近端髓内钉(PFN)等术式治疗,并评价其手术疗效,提出本院分型方法,寻找各种分型方法对指导术式选择的意义。结果随着对股骨粗隆间骨折诊治认识的提高、内固定器材的进展,原骨折分型的指导意义和实用性渐显不足。由此导致术式选择不当将影响手术疗效。结论股骨粗隆间骨折手术治疗以DHS、PFN术式为首选,本院提出的新的骨折分型有利于判断骨折稳定性,预防髋内翻和指导术式选择。

Classification of Intertrochanteric Fracture and Selection of Its Internal Fixation Methods

Objective To study the classification and the choice of clinical surgical methods in order to improve the clinical outcome based on the advances in diagnosis and treatment of femoral intertrochanteric fracture.Methods Between January 2004 and January 2006,eighty patients with femoral intertrochanteric fracture were treated with external fixation,plate,DHS or PFN based on their classification of fracture and their general condition.Their clinical outcome was evaluated.A new method of classification was proposed by our hospital and its significance for the guidance of the choice of surgical pattern was evaluated.Results As the improvement on the diagnosis and treatment of femoral intertrochanteric fracture and the advancement of internal fixation device,the significance of guidance and the practicability of the original classification has been insufficient,which may result in the improper choice of surgical pattern,affecting the clinical outcome.Conclusion The first choice for the surgical treatment of femoral intertrochanteric fracture is DHS and PFN.The new method of classification proposed by out hospital is good for the judgment of the stability of the fracture,for the prevention of hip turns and for the guidance of the choice of surgical pattern.