DHS与Intertan髓内钉治疗股骨粗隆间骨折疗效分析

目的]探讨DHS与Intertan髓内钉治疗股骨粗隆间骨折的适应证、手术技巧及临床疗效.方法]2008年2月～2010年2月收治52例股骨粗隆间骨折患者,男24例,女28例；年龄38～ 89岁(平均68.1岁),骨折按Evans分型,均为顺粗隆间骨折,其中Ⅰ型8例,Ⅱ型10例,Ⅲ型18例,Ⅳ型16例.行DHS内固定37例,行Intertan髓内钉内固定15例；从手术情况、骨折愈合时间、术后Harris髋关节评分及术后并发症等方面分析比较.结果]所有患者术后获平均24个月(17 ～38个月)随访,在手术时间、术中失血量、平均骨折愈合时间、术后Harris髋关节评分及术后并发症的发生上两组有明显差异(P＜0.05).结论]对于Evans Ⅰ型股骨粗隆间骨折应用DHS内固定可取得良好的效果,对于EvansⅡ型适用Intertan髓内钉,也可用DHS；对于EvansⅢ、Ⅳ型最适用Intertan髓内钉；Intertan髓内钉设计更符合股骨近端生物力学特点,有效恢复股骨近端稳定性,适用于粉碎性、复杂及合并骨质疏松的股骨粗隆间骨折,可缩短卧床时间,提高生活质量,减少并发症.

Analysis of the DHS and Intertan nails for the intertrochanteric fracture

Objective]To investigate the indications,operative skills and clinical efficacy of the DHS and Intertan nails for the intertrochanteric fractures. Method]A series of 52 cases of intertrochanteric fractures were fixed by DHS and Intertan during February 2008 to February 2010.These 52 patients included 24 males and 28 females,with the age ranging from 38 to 89 years old(mean,68.1 years).According to Evans classification of all these patients,there were 8 cases of type Ⅰ,10 of type Ⅱ,18 of type Ⅲ and 16 of type Ⅳ.Among them,37 patients were treated with DHS,and 15 with Intertan nails.The surgical data,fracture healing time,postoperative Harris hip score and postoperative complications between these two groups were analyzed. Result]All the patients were followed up by 24 months in average(ranging,17-38 months).There were statistically significant differences(P<0.05) between these two groups in the surgical time,blood loss,fracture healing time,postoperative Harris hip score and complications. Conclusion]DHS is applicable for typeⅠEvans intertrochanteric fractures.Both DHS and Intertan are suitable for the type Ⅱ,and for type Ⅲ and type Ⅳ,Intertan is a better choice.Because of the bio-mechanical design according to the characteristics of the proximal femur,Intertan can efficiently help regain the stability of proximal femur and it can be used to treat the comminuted,complicated or osteoporotic intertrochanteric fractures.It can also shorten the bedtime,improve the life quality and decrease the incidence rate of complications.