经皮加压钢板与动力髋螺钉治疗转子间骨折文献的Meta分析

目的：通过比较经皮加压钢板（PCCP）及动力髋螺钉（DHS）固定的临床结果及安全性，明确经皮加压钢板治疗转子间骨折的特点。方法：系统地回顾2000年1月-2013年1月Medline、Embase、Sciencedirect、OVID、Cochrand Central database和中国生物医学文献数据库中的相关研究，比较PCCP及DHS治疗稳定转子间骨折的随机对照试验及准随机对照试验。结果：与DHS相比，PCCP可明显地缩短手术时间，减少失血及输血，并降低心血管事件的发生率。结论：PCCP具有明显地缩短手术时间、减少失血、降低心血管事件发生率等优势。     

动力髋螺钉与经皮加压钢板固定股骨转子间骨折的三维有限元分析

[目的]通过三维有限元法对DHS及PCCP固定股骨转子间骨折的生物力学稳定性进行对比,为临床应用提供理论依据.[方法]建立Evans-JensenⅡ型骨折内固定三维有限元模型,研究不同内固定的yon Mises应力分布、股骨近端的von Mises应力分布及骨折面接触压力,分析骨折固定后生物力学稳定性.[结果]PCCP固定模型内固定的von Mises的总体应力较均匀,最大应力较小;股骨近端的von Mises的总体应力较均匀,未见明显应力集中现象;骨折面接触压力的总体应力较高,分布均匀.[结论] PCCP固定Evans-JensenⅡ型转子间骨折的生物力学稳定性较DHS更具优势.     

经皮加压钢板和动力髋螺钉治疗股骨转子间骨折

目的:比较经皮加压钢板与动力髋螺钉治疗股骨转子间骨折的疗效。方法:将75例股骨转子间骨折患者前瞻性分为两组治疗,经皮加压钢板组(PCCP组)42例,动力髋螺钉组(DHS组)33例,比较两组手术时间、术后血红蛋白丢失量、骨折愈合时间、术后6个月及末次Harris评分。结果:PCCP组4例失访,38例平均随访(12.1±3.3)个月;DHS组3例失访,30例平均随访(13.4±3.6)个月,PCCP组手术时间、失血量、愈合时间、末次Harris评分显著优于DHS组(P<0.05)。结论:相对于DHS而言,PCCP治疗股骨转子间骨折具有手术时间短、软组织剥离少、出血少、患者能早期活动等优点。     

动力加压髋螺钉内固定治疗股骨转子间骨折

目的探讨动力加压髋螺钉（DHS）内固定治疗股骨转子间骨折的效果。方法采用DHS内固定治疗40例股骨转子间骨折患者。结果40例均获随访,时间6-20个月,骨折愈合时间14-20周,平均15周,关节功能恢复良好。按黄公怡等方法进行评定,优23例,良17例。结论DHS系统治疗股骨转子间骨折,固定牢靠,可早期关节活动,缩短卧床和住院时间,疗效可靠。     

动力髋螺钉治疗股骨转子间骨折

2001～2004年,我院应用动力髋螺钉治疗股骨转子间骨折75例,取得满意效果。     

动力髋螺钉治疗股骨转子间骨折

目的 评价动力髋螺钉(DHS)治疗股骨转子间骨折的临床效果。方法 1996年3月～2002年3月用DHS共治疗患者29例．骨折按Evans分型，本组Evans ⅠA2例，Evans ⅠB 10例，Evans ⅡA 3例，Evanslib12例，Evans Ⅲ2例．结果 29例患者均获随访，随访12～48个月，平均26个月，根据Harris髋关节评分：优16例，良9例，中3例，差1例。结论 如能及时手术良好复位，DHS是治疗股骨转子间骨折的较好选择。     

动力髋螺钉治疗股骨转子间骨折

我院2000～2004年采用动力髋螺钉治疗股骨转子间骨折60例,取得满意效果。     

动力髋钢板螺钉在治疗股骨转子间骨折中的应用

我院自2001年2月～2003年11月共收治各型股骨转子间骨折患47例，其中36例采用动力髋钢板螺钉(DHS)内固定，钢丝捆扎固定大小转子，术后辅以CPM锻炼治疗，均取得了满意的效果。现分析报告如下：     

动力髋螺钉内固定治疗股骨转子间骨折

目的探讨动力髋螺钉（DHS）治疗股骨转子间骨折的方法及疗效。方法采用DHS治疗105例股骨转子间骨折患者。结果患者均获得随访,时间15～36个月,100例骨折愈合,时间15～20（16±2.3）周,关节功能恢复良好。参照黄公怡等方法进行评定：优84例,良11例,可5例,差5例。2例Ⅲ型、3例Ⅳ型骨折者发生钢板螺钉松动,改行骨水泥型人工股骨头置换治疗。结论严格掌握DHS手术适应证,规范化操作,提高手术技巧,DHS是治疗股骨转子间骨折的有效方法。     

动力髋螺钉治疗股骨转子间骨折56例疗效分析

目的探讨动力髋螺钉在股骨转子间骨折治疗中的疗效。方法对我科2006年7月至2009年12月期间用DHS治疗的56例股骨转子间骨折病例,据骨折愈合情况、有无并发症和髋关节功能情况进行评价。结果 56例均获随访,随访18～26个月,平均20个月。56例患者骨折愈合良好,髋关节功能恢复良好,无切口感染、内固定失败、髋内翻、股骨头坏死以及骨不连等并发症。结论动力髋螺钉内固定术是治疗股骨转子间骨折较有效的方法。     

经皮加压钢板和动力髋螺钉治疗老年股骨转子间骨折的疗效比较

目的 比较经皮加压钢板(PCCP)和动力髋螺钉(DHS)治疗老年股骨转子间骨折的疗效.方法 对2007年1月至2010年1月收治的98例老年股骨转子间骨折患者(AO 31.A1-A2)进行回顾性分析,根据内固定方法不同分为PCCP组和DHS组,PCCP组53例,男10例,女43例;平均年龄78.2岁;AO分型:A1型37例,A2型16例.DHS组45例,男7例,女38例;平均年龄75.4岁;AO分型:A1型28例,A2型17例.比较两组患者的手术时间、失血量、骨折愈合时间及末次随访时Harris评分.结果 PCCP组有2例失访,51例患者术后获平均11.6个月(8～24个月)随访;DHS组有3例失访,42例患者术后获平均14.2个月(10～26个月)随访.PCCP组在手术时间、失血量、愈合时间及末次随访时Harris评分明显优于DHS组,差异均有统计学意义(P＜0.05).两组患者术后均末出现感染、骨不连、钢板螺钉断裂、股骨头螺钉切割、松动移位及股骨头坏死等并发症.结论 与DHS比较,PCCP治疗老年股骨转子间骨折具有手术时间短、切口小、剥离肌肉少、出血少、术后疼痛轻及患者能早期活动等优点.

Abstract：

Objective To investigate the clinical outcomes of minimally invasive treatment of elderly patients with intertrochanteric hip fractures with percutaneous compression plate (PCCP) as compared with dynamic hip screw (DHS) .Methods We randomised 98 patients with intertrochanteric fractures (AO31.A1-A2) to surgical treatment with either the PCCP or DHS and followed them post-operatively from January 2007 to January 2010.There were 53 cases in the PCCP group and 45 in the DHS group.The operation time, blood loss, fracture healing time and the last Harris scores were recorded and compared between the 2 groups.Results In the PCCP group 51 cases obtained a mean follow-up of 11.6 months (range, 8 to 24) and 2 were lost to the follow-up.In the DHS group 42 cases obtained a mean follow-up of 14.2 months (range, 10 to 26) and 3 were lost to the follow-up.Shorter operation time and fracture healing time, less blood loss and higher Harris scores were achieved in the PCCP group than in the DHS group.The differences between the 2 groups were statistically significant ( P ＜ 0.05) .Conclusion The minimally invasive PCCP technique can result in a lower blood loss, less post-operative pain, fewer implant-related complications and comparable surgery time than the DHS treatment.     

Percutaneous compression plating versus compression hip screw fixation for the treatment of intertrochanteric hip fractures

Percutaneous compression plate (PCCP) devices are used for the fixation of intertrochanteric hip fractures by a minimally invasive technique. One hundred and eight patients who underwent this procedure were retrospectively compared with 155 patients who underwent compression hip screw (CHS) fixation. The general characteristics of the two groups, including age, sex, side of injury and co-morbidities assessed by the ASA score were similar. The operative time was significantly shorter in the PCCP group (67 versus 87 min, p=0.00). Postoperative blood transfusions were not required in 40% of the patients in the PCCP group compared to 24% of the patients in the CHS group (p<0.01). The rate of systemic postoperative complications was lower in the PCCP group (p=0.02) both in univariate and multivariate analyses. A considerable reduction was observed in cardiovascular complications (OR=3.1, p<0.05). Length of hospitalisation, implant failure and mortality rates were not significantly different between the two study groups. We conclude that the PCCP device offers several advantages over CHS device and may improve the current treatment of intertrochanteric hip fractures while maintaining a similar success rate in fracture fixation.     

Minimally invasive percutaneous compression plating versus dynamic hip screw for intertrochanteric fractures: a randomized control trial

Objective：Intertrochanteric femur fracture is a common injury in elderly patients.The dynamic hip screw （DHS） has served as the standard choice for fixation; however it has several drawbacks.Studies of the percutaneous compression plate （PCCP） are still inconclusive in regards to its efficacy and safety.By comparing the two methods,we assessed their clinical therapeutic outcome.Methods：Atotal of 121 elderly patients with intertrochanteric femur fractures （type AO/OTA 31.A 1-A2,Evans type 1） were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation.Results：The mean operation duration was significantly shorter in the PCCP group （55.2 min versus 88.5 min,P＜0.01）.The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHS group （P＜0.01）.Among the patients treated with PCCP,3.1％ needed blood transfusions,compared with 44.6％ of those that had DHS surgery （P＜0.01）.The PCCP group displayed less postoperative complications （P＜0.05）.The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group.There were no significant differences in the mean hospital stay,mortality rates,or fracture healing.Conclusion：Due to several advantages,PCCP has the potential to become the ideal choice for treating intertrochanteric fractures （type AO/OTA 31.A1-A2,Evans type 1）,particularly in the elderly.     

A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip

Limited access surgery is thought to reduce post-operative morbidity and provide faster recovery of function. The percutaneous compression plate (PCCP) is a recently introduced device for the fixation of intertrochanteric fractures with minimal exposure. It has several potential mechanical advantages over the conventional compression hip screw (CHS). Our aim in this prospective, randomised, controlled study was to compare the outcome of patients operated on using these two devices. We randomised 104 patients with intertrochanteric fractures (AO/OTA 31.A1-A2) to surgical treatment with either the PCCP or CHS and followed them for one year postoperatively. The mean operating blood loss was 161.0 ml (8 to 450) in the PCCP group and 374.0 ml (11 to 980) in the CHS group (Student's t-test, p < 0.0001). The pain score and ability to bear weight were significantly better in the PCCP group at six weeks post-operatively. Analysis of the radiographs in a proportion of the patients revealed a reduced amount of medial displacement in the PCCP group (two patients, 4%) compared with the CHS group (10 patients, 18.9%); Fisher's exact test, p < 0.02. The PCCP device was associated with reduced intra-operative blood loss, less postoperative pain and a reduced incidence of collapse of the fracture.     

锁定钢板和动力髋螺钉治疗股骨转子骨折

目的探讨锁定钢板和动力髋螺钉治疗股骨转子骨折的临床疗效。方法将88例股骨转子骨折患者随机分为锁定钢板组(44例)和动力髋螺钉组(44例),对两组患者的临床治疗效果进行比较分析。结果与动力髋螺钉组比较,锁定钢板组手术时间和术中出血量均较少,差异有统计学意义(P<0.05)。与动力髋螺钉组比较,锁定钢板组优良率高,愈合时间有所减少,内固定断裂松动、股骨头切割、肢体短缩、髋内翻等并发症的发生率均较低,但差异均无统计学意义(P>0.05)。结论锁定钢板和动力髋螺钉均为股骨转子骨折的有效治疗方式,但锁定钢板比动力髋螺钉的适用范围更广,临床疗效更好。     

The percutaneous compression plate versus the dynamic hip screw: a meta-analysis

Intertrochanteric fractures are a significant orthopaedic burden. The aim of this study was to assess how the Percutaneous Compression Plate (PCCP) technique performs compared to the traditional dynamic hip screw (DHS). A meta-analysis of all head to head trials (1995-2006) comparing the two techniques was performed. Early mortality (< or = 1 year) was the major outcome of interest. Secondary outcomes of interest included operation time (minutes), blood transfusion requirements, post-operative infection and length of stay in hospital (days). There was a decreased trend in overall mortality in the PCCP group [CI 0.84, (0.48 to 1.47), Chi-square = 1.36, p = 0.51]. Similar trends favouring the PCCP technique were seen with the other outcomes. PCCP being a relatively new technique has the potential to become the gold standard in the repair of intertrochanteric hip fractures. However, owing to the limitations of this meta-analysis, a large randomised controlled trial is required.     

锁定加压钢板和动力髋螺钉治疗老年股骨粗隆间骨折疗效分析

股骨粗隆间骨折好发于老年人,其发生率随年龄的增大而上升.由于非手术治疗卧床时间长,全身并发症多见,目前多主张早期复位内固定手术及功能锻炼,尽快使患者康复,避免各种并发症的发生.目前应用于粗隆间骨折的内固定装置比较多,各种报道也比较多,但具体应用仍有分歧.我们回顾性分析72例老年股骨粗隆间骨折患者经锁定加压钢板(LCP)和动力髋螺钉(DHS)治疗后的早期疗效及其优劣,现报告如下.