髓内与髓外固定股骨转子间骨折的预后比较

背景：目前股骨转子间骨折临床多采用早期内固定治疗,随着现代医学及内固定器材等相关科学的发展,股骨转子间骨折的修复方式较多。然而股骨转子间骨折内固定方式及内固定类型的选择临床上存在较多争议。目的：对股骨转子间骨折髓内与髓外固定的临床预后进行对比分析。方法：选取2009年7月至2013年7月宣城中心医院收治的股骨转子间骨折患者146例,根据内固定方式不同分为3组,其中锁定加压钢板组者31例,动力髋螺钉组者66例,股骨近端抗旋髓内钉组者49例。动力髋螺钉组和锁定加压钢板均属于髓外固定系统,股骨近端抗旋髓内钉属于髓内固定系统。通过对比各组患者的手术时间、术中失血量、切口长度及临床疗效,探讨不同内固定方式对股骨转子间骨折预后的指导意义。结果与结论：所有患者均获得术后随访,随访时间为4个月-3年。与锁定加压钢板组及动力髋螺钉组比较,股骨近端抗旋髓内钉组的手术时间及术中出血量较少,差异有显著性意义（P〈0.05）;其中锁定加压钢板组的手术时间显著低于动力髋螺钉组（P〈0.05）。股骨近端抗旋髓内钉组的疗效优良率（94%）显著高于锁定加压钢板组（81%）及动力髋螺钉组（83%）,差异有显著性意义（P〈0.05）。提示应用髓内及髓外固定系统股骨转子间骨折患者均可取得良好的修复效果,但髓内固定系统较髓外固定系统在手术时间、失血量及患者内固定后疗效上更具优势。

Comparison of intramedullary fixation and extramedullary fixation for intertrochanteric fractures

BACKGROUND： The intertrechanteric fracture is often treated with early internal fixation. As the modern medicine and internal fixation device develop, a variety of methods emerge to restore intertrechanteric fractures. However, the type of internal fixation and choice of internal fixators remain controversial. OBJECTIVE： To analyze and compare clinical prognosis of intertrochanteric fracture after intramedullary fixation and extramedullary fixation. METHODS： A total of 146 patients with intertrochanteric fractures were recruited from Anhui Province Xuancheng Central Hospital between July 2009 and July 2013, and were divided into three groups according the types of internal fixation： locking compression plate （n=31）, dynamic hip screw （n=66） and proximal femoral nail anti-rotation （n=49）. The locking compression plate and dynamic hip screw belong to extramedullary fixation system, while proximal femoral nail anti-rotation was intramedullary fixation system. The operation time, intraoperative blood loss, length of the incision, and clinical curative effect were observed and compared among three groups, to explore the influence of internal fixation type on the prognosis of intertrechanteric fracture. RESULTS AND CONCLUSION： The involved patients were followed up for 4-36 months. Compared with locking compression plate and dynamic hip screw groups, the operation time and intraoperative blood loss were significantly reduced in the proximal femoral nail anti-retation group （P 〈 0.05）; the locking compression plate group had significantly shorter operation time than the dynamic hip screw group （P 〈 0.05）. The excellent and good rate of the proximal femoral nail anti-rotation group （94%） was significantly higher than that in the locking compression plate group （81%） and dynamic hip screw group （83%） （P 〈 0.05）. Experimental findings indicate that, both intramedullary fixation and extramedullary fixation can achieve good effect in restoring intertrochanteric fractures, a