DHS、Gamma钉内固定治疗股骨转子间合并转子下骨折比较

目的 评估DHS（动力髋）和Gamma钉内固定治疗股骨转子间合并转子下骨折的手术方法和疗效。方法诊断明确后，入院都行胫骨结节骨牵引固定，并于伤后1～2周内由同组医师行DHS或Gamma钉复位内固定治疗。记录手术时间，X线透视下显露时间，术中出血量，髋关节功能恢复，髋内翻，下肢短缩，伤口感染。比较分析2004年6月～2008年5月用DHS和Gamma钉治疗股骨转子间合并转子下骨折76例。结果65例患者获得较完整随访，DHS组35例，Gamma钉组30例。随访时间16～48个月（平均26个月）。DHS组手术时间，X线下暴露时间明显短于Gamma钉组，术中出血量无明显差异。按Harris髋关节功能评分标准，DHS组优良率92．5％，Gamma钉组优良率80．56％。结论股骨转子间骨折合并转子下骨折手术治疗中宜采用DHS内固定。

The compartive therapy of intertrochanteric femoral fractures combined subtrochanteric fracture with DHS and Gamma nail

Objective To assess the efficacy and surgical technique of DHS （dynamic hip screw） and Gamma nail for internal fixation of intertrochanteric femoral fracture combined subtrochanteric fracture. Methods After diagnosis, patients admitted to hospital will do tibial tubercle bone traction, 1-2 weeks later after injury, the DHS or Gamma nail internal fixation were carried out by the same group of physicians. Record rhe operation time, under X-ray exposure time, the volume of bleeding in surgery, functional recovery of hip joint, whether coxa vara, the shortening degree of lower limb, whether wound infection.analysis 76 cases of intertrochanteric femoral fractures combined subtrochanteric fracture treated by DHS or Gamma nail from June 2004 to May 2008. Results 65 cases with complete follow-up,DHS group 35 cases, Gamma nail group 30 cases.the follow up was 16-48 months （average 26 months）.the operation time and the exposure time under X-ray of DHS group is shorter than Gamma nail group.the volume of bleeding in surgery is no significant difference .according the criteria of Harris hip function score,the rate of excellent for DHS group is 92.5%and 80.56% for Gamma nail group. Conclusion This study demonstrates that DHS internal fixation in intertrochanteric fracture combined subtrochant-eric fracture is better than Gamma nail.