股骨粗隆下骨折的分型与手术治疗策略

目的讨论股骨粗隆下骨折的诊断分型和手术治疗策略，评价采用加长型伽马钉内固定治疗股骨粗隆下骨折的临床疗效。方法自2006-12—2012-12采用加长型伽马钉内固定治疗股骨粗隆下骨折33例，骨折按AO分型．针对不同骨折类型采用不同方法进行辅助复位，复位满意后按伽马钉操作常规置入髓内钉。术后1年采用创伤髋关节评分系统进行功能评价。结果33例均获得随访时间12～36个月，平均18个月。所有骨折均一期愈合。术后1年按创伤髋关节评分系统进行功能评价：优28例，良3例，可2例，优良率93．9％。结论股骨粗隆下骨折的AO分型简单实用，可有效指导临床治疗。采用多功能骨科牵引床牵引结合股骨粗隆下小切口辅助复位、加长伽马钉内固定治疗股骨粗隆下骨折是一种理想的手术方式。

Classifications and operative treatment strategies of subtrochanteric femur fractures

Objective To investigate the classifications and treatment strategies of subtrochanteric femur fractures and evaluate the functional outcome with the use of long Gamma nails to treat the subtrochanteric fractures. Methods Over a six-year period, the long Gamma nails were used to treat a consecutive series of 33 patients （33 hips） who had sustained a subtrochanteric femur fractures under the guide of AO classification. The clinical outcomes were evaluated according to the Traumatic Hip Rating Scale （THRS） one year later after the surgery. Results All the 33 patients were followed-up for 12 to 36 months. All fractures were primary healing. The 31 patients （93.9%） were evaluated excellent or good with regard to the functional outcomes （excellent： 28 patients, good： 3, fair. 2）. Conclusion The AO classification of subtrochanteric femur fractures is convenient and effective for the treatment. The long Gamma nails are associated with favorable functional outcomes. The limited incision is often useful and necessary for reduction.