股骨近端锁定解剖钢板与传统动力髋螺钉置入内固定治疗股骨转子间骨折的比较

背景：目前治疗股骨转子间骨折的内固定有动力髋螺钉、Gamma钉、股骨近端交锁髓内钉等，究竟使用何种内固定目前仍存在争议。近年来股骨近端锁定解剖钢板逐渐被用于治疗股骨转子间骨折。 目的：比较股骨近端锁定解剖钢板内固定与传统动力髋螺钉内固定治疗股骨转子间骨折的临床效果。 方法：2007-05/2009-06收治股骨转子间骨折患者48例，按随机数字表法分为2组，股骨近端锁定解剖钢板内固定组及传统动力髋螺钉内固定组各24例。比较两组患者手术时间、术中出血量、伤口引流量、下地时间及内固定后髋关节功能恢复情况。 结果与结论：所有患者均获得随访，随访5~18个月，平均12.6个月。两组间伤口引流量、下地时间差异无显著性意义(P > 0.05)。解剖钢板组较动力髋螺钉组手术时间更短，术中出血更少(P < 0.05)。内固定后两组Harris髋关节功能评分较治疗前明显改善，解剖钢板组优良率更高，但差异无显著性意义(P > 0.05)。提示与传统动力髋螺钉内固定相比，股骨近端解剖钢板内固定治疗股骨转子间骨折手术时间短、术中出血量少、术后功能恢复良好，是一种较为理想的治疗手段。

Anatomical plate versus dynamic hip screw internal fixation for the treatment of femoral intertrochanteric fractures

BACKGROUND: Dynamic hip screw (DHS), Gamma nail, and femoral proximal interlocking intramedullary nail have been used in internal fixation of femoral intertrochanteric fractures. Anatomical plate has been recently used for the treatment of femoral intertrochanteric fractures. OBJECTIVE: To compare the therapeutic results of internal fixation by anatomical plate and DHS for treatment of femoral intertrochanteric fractures. METHODS: Between May 2007 and June 2009, 48 consecutive patients with femoral intertrochanteric fractures were randomly assigned to anatomical plate fixation and control group (DHS fixation) with 24 cases in each group. The operative time, blood loss, walking time and hip function scores were recorded. RESULTS AND CONCLUSION: All patients were followed up for 12.6 (range 5 to 18 months). The wound drainage and walking time was similar in two groups (P > 0.05). The mean operative time and blood loss in the experimental group were significantly lower than the control group (P < 0.05). Preoperative Harris hip score of the two groups were significantly improved postoperatively, and good and excellent was better in experimental group, but there was no significant difference between two groups (P > 0.05). Results demonstrated that internal fixation by anatomical plate is a better treatment for femoral intertrochanteric fractures compared with the traditional DHS due to its easier operation, less bleeding and similar effect.