髋部髓内加压螺钉和股骨近端短重建钉置入后的生物稳定性比较：随机对照

背景：髋部髓内加压螺钉和股骨近端短重建钉因手术操作简单，以及针对亚洲人的特殊设计，适合应用于股骨转子间骨折，但是目前缺乏两者临床疗效比较的研究报道。目的：比较髋部髓内加压螺钉和股骨近端短重建钉置入治疗股骨转子间骨折的效果。方法：将215例股骨转子间骨折患者抽签随机分为2组干预：髓内加压螺钉组110例，股骨近端短重建钉组105例，通过观察失血量、输血量、手术时间、死亡率、术后并发症、行走能力等指标比较两组的临床疗效。结果与结论：两组术中失血量、输血量、手术时间及死亡率差异均无显著性意义。髓内加压螺钉组35例能够独立步行，57例需要步行辅助器行走，18例无法行走。股骨近端短重建钉组28例患者能够独立步行，48例需要步行辅助器行走，29例无法行走。髓内加压螺钉组活动功能优于股骨近端短重建钉组(P < 0.05)，并发症发生率低于股骨近端短重建钉组。表明髓内加压螺钉相对于股骨近端短重建钉能方便、准确、稳定的进行骨折内固定，并且提供术中加压，促进骨折愈合，并发症率较低，更适合应用于转子间骨折。

Intramedullary hip screw versus proximal femoral nail for intertrochanteric fracture: A randomized controlled study

BACKGROUND: Intramedullary hip screw (IMHS) and proximal femoral nail (PFN) have been used to treat intertrochanteric fracture due to simple operation and appropriate designs for the Asian. However, little data are available on curative effects comparison between them. OBJECTIVE: To compare the effects of IMHS and PFN on treating intertrochanteric fracture.METHODS: A total of 215 patients with intertrochanteric fracture were randomized in two groups, IMHS group (n=110) and PFN group (n=105). Blood loss, operative time, mortality rate, postoperative complications, and walking ability of two groups were compared. RESULTS AND CONCLUSION: There were no significant differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In IMHS group, 35 patients could walk independently, 57 walk with assistive device, and 18 could not walk, while in PFN group, 28 patients could walk independently, 48 walk with assistive device, and 29 could not walk. The movement function of IMHS group was better than PFN group (P < 0.05), and the number of total complications was significantly less in the IMHS group. These results indicate that IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS can improve fracture healing, result in few complications and is more appropriate for intertrochanteric fracture.