两种入路带锁髓内钉治疗成人股骨干骨折的比较研究

目的比较大粗隆入路带锁髓内钉与梨状窝入路带锁髓内钉内固定治疗成人股骨干骨折的临床疗效。方法自2005年3月—2013年3月应用大粗隆入路带锁髓内钉和梨状窝入路带锁髓内钉内固定治疗成人股骨干骨折87例,其中应用大粗隆入路带锁髓内钉内固定治疗37例,应用梨状窝入路带锁髓内钉内固定治疗50例,对两组分别就其平均手术时间、髋关节功能评分标准(Harris评分)两项指标进行比较分析。结果 81例获得随访,随访时间10~26个月,平均13个月。大粗隆入路组的平均手术时间为(56±5)min,梨状窝入路组的平均手术时间为(86±6)min,两组比较,差异有统计学意义(P<0.05)。根据Harris评分,大粗隆入路带锁髓内钉固定组功能恢复优良率91.9%;梨状窝入路带锁髓内钉固定组功能恢复优良率74.0%。两组比较差异有统计学意义(P<0.05)。结论两种入路带锁髓内钉治疗成人股骨干骨折均可获得满意的临床效果,但大粗隆入路带锁髓内钉较梨状窝入路带锁髓内钉操作更加方便快捷,创伤小,髋关节功能恢复满意。

Comparison of two approaches to treatment of adult femoral shaft fractures with interlocking intramedullary nailing

Objective To compare the clinical results of adult femoral shaft fractures treated with interlocking intramedullary nailing via trochanteric approach and piriform fossa approach. Methods From March 2005 to March 2013, 87 adult patients with femoral shaft fractures were treated with interlocking intramedullary nailing through trochanteric and piriform fossa surgical approaches. Thirty-seven patients were treated through the trochanteric surgical approach, and the other 50 ones through the piriform fossa surgical approach. Mean operation time and Harris hip score were recorded and compared. Results Eighty-one cases were followed up successfully with a mean period of 13 （ 10 - 26 ） months. The average operation time was （ 56 ＋ 5 ） minutes in the fixation of interlocking intramedullary nailing through trochanteric surgical approach group, and （86 ＋ 6 ） minutes in the piriform fossa surgical approach group. The excellent rate of function recovery of trochanteric surgical approach group was 91.9% by Harris hip score, and that of the piriform fossa surgical approach group was 74.0%. There was a significantly difference in terms of mean operation time and Harris hip score between the two groups （ P 〈 0.05 ）. Conclusion Compared with the piriform fossa surgical approach, the fixation of interlocking intramedullary nailing through trochanteric surgical approach is a good method to the treatment of femoral shaft fractures in adults due to less injury, less complication and satisfactory effect.