加长型与短型髓内钉治疗高龄股骨粗隆间骨折的疗效比较

目的比较Gamma加长型与短型髓内钉治疗高龄股骨粗隆间骨折的疗效。方法回顾性分析2011年1月~2013年12月收治的56例高龄股骨粗隆间骨折(Müller AO/OTA31-A1/A2)患者的临床资料,其中男性37例,女性19例,年龄65~88岁,平均(72.18±5.23)岁。其中使用Gamma短型髓内钉33例男性21例,女性12例;平均年龄(73.21±6.24)岁],Gamma加长型髓内钉23例男性16例,女性7例;平均年龄(68.88±7.61)岁]。比较两组术中出血量、手术时间、术后血红蛋白、术日输血率、住院时间、术后1年Harris评分。结果加长型组出血量(149.11±87.31)m L,手术时间(73.80±17.40)min,术后1d血红蛋白(101.13±1.21)g/L,输血15例(65.2%),住院时间(14.12±0.23)d,术后1年Harris评分(90.20±1.70)分。短型组出血量(93.25±61.26)m L,手术时间(53.30±15.70)min,术后1d血红蛋白(102.47±1.32)g/L,输血12例(36.4%),住院时间(13.38±0.97)d,术后1年Harris评分(88.90±2.31)分。两组术中出血量、手术时间、术日输血率比较差异有统计学意义(P0.05);血红蛋白量、住院时间、术后1年Harris评分差异无统计学意义。结论加长型与短型髓内钉治疗AO/OTA31-A1型和31-A2型股骨粗隆间骨折在术后功能恢复上无差异,术后随访短型髓内钉更具有优势。

Long versus short intramedullary nails for treatment of femoral intertrochanteric fractures

Objective To compare the treatment of intertrochanteric fracture with Gamma long versus short intramedullary nails .Methods Fifty-six elderly patients with intertrochanteric fracture of femur ( AO/OTA31-A1;A2,37 males,19 females) were divided into short intramedullary nails group including 21 males and 12 females with a mean age of (73.21 ±6.24) years] and long intramedullary nails group including 16 males and 7 females with a mean age of (68.88 ±7.61) years].Medical records were reviewed for age ,gender,estimated blood loss, operative time ,preoperative hemoglobin ,transfusion rate ,length of stay and Harris scores 1 year after the operation . Results The average estimated blood loss (149.11 ±87.31)mL] and transfusion rate(65.2%) for long nails were found to be significantly greater (P<0.01) than the average estimated blood loss (93.25 ±61.26 )mL] and transfusion rate(36.4%) for short nails.The average operative time was also found to be significantly greater (P<0.01) for long (73.80 ±17.40) minutes] than for short (53.30 ±15.70) minutes] intramedullary nail proce-dures.But there was no significant difference in preoperative hemoglobin ,length of stay and Harris scores 1 year af-ter the operation.Conclusion Short intramedullary nails were found to be better than long intramedullary nails for less operation wound .