不稳定股骨转子间骨折不同内固定方法疗效比较

目的 比较4种不稳定股骨转子间骨折内固定方法的疗效。方法 2000年1月-2004年12月，不稳定股骨转子间骨折内固定并获随访1年以上患者88例，男52例，女36例。年龄19～86岁。受伤至手术时间2～9d。致伤原因：高处坠落伤22例，交通事故伤36例，摔伤20例，跌伤10例。分别采用动力髋（dynamic hip screw，DHS）固定42例（A组）；解剖钢板固定23例（B组）；股骨近端交锁钉（proximal femoral nail，PFN）固定8例（c组）；动力髁螺钉（dynamic condylar screw，DCS）固定15例（D组）。按照改良Evan’s分类均为不稳定性骨折；其中A组Ⅲ、Ⅳ、Ⅴ型分别为15、8、19例，B组分别为12、5、6例，C组分别为3、2、3例，D组分别为10、3、2例。记录患者的手术时间、术中出血量、术中X线暴露次数及术后并发症、骨折临床愈合时间，术后髋关节功能评分等相关数据，进行统计学处理。结果术后患者均获随访12-48个月，平均18个月。各组骨折术后3～5个月均获临床愈合。住院期间无死亡，随访6个月死亡5例，均死于心脑血管疾病。术后A组3例，C组1例，D组3例并发髋内翻。各组手术时间，术中并发症比较，差异无统计学意义（P〉0．05）。A组术中出血量最多，B组最少，与C、D组比较，差异均有统计学意义（P〈0．05）；C、D组间比较，差异无统计学意义（P〉0．05）。B组术中X线暴露次数最少、临床愈合时间较长、无术后并发症，与其余各组比较，差异有统计学意义（P〈0．05）。D组术后功能评分最低，与其余各组比较，差异有统计学意义（P〈0．05）。结论 解剖钢板对于不稳定股骨转子间骨折是一种行之有效的较好方法，手术操作相对简便，术后髋关节功能恢复较好。

COMPARISON OF VARIOUS KINDS OF INTERNAL FIXATIONS IN UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURE

OBJECTIVE: To explore the effects of various kinds of internal fixations on unstable intertrochanteric femoral fractures. METHODS: From January 2000 to December 2004, 88 cases of unstable intertrochanteric femoral fractures were treated. There were 52 males and 36 females (aged 19-86 years). Twenty-two cases were caused by fall from height, 36 by motor vehicle accident and 20 by fall and 10 by tumble. They were divided into 4 groups according to 4 kinds of internal fixations: dynamic hip screw (DHS, group A, n=42), anatomical proximal femur bone plate (group B, n = 23), proximal femoral nail (PFN, group C, n = 8)and dynamic condylar screw (DCS, group D, n = 15). According to the modified Evan's classification, fractures were all unstable type and were classified as follow types: group A (15 type III, 8 type IV and 19 type V); group B (12 type III, 5 type IV and 6 type V); group C (3 type III, 2 type IV and 3 type V); and group D (10 type III, 3 type IV and 2 type V). The data of operative time, intra-operative blood loss, intra-operative complications, fluoroscopy exposures, clinical healing time of fracture, post-operative restored function and postoperative complications were recorded and analyzed statistically using the SPSS 12.0 software package. RESULTS: All patients were followed up for 12-48 month (18 months on average). All patients achieved clinical healing. Coxa varus occurred in 3 cases of group A, in 1 case of group C and in 3 cases of group D. The differences were of no statistical significance in operative time and postoperative complications between 4 groups (P>0.05). The difference was of statistical significance in the blood loss between groups A, B and groups C, D (P<0.05) but no statistical significance between group C and group D (P>0.05). The difference was of statistical significance in the fluoroscopy exposures, clinical healing time of fracture and postoperative complications between group B and the other groups (P<0.05). The difference was of statistical significance in the post-operative restored functions between group D and the other groups (P<0.05). CONCLUSION: The anatomical proximal femur bone plate is a useful device in the treatment of unstable intertrochanteric femoral fracture. The operative manipulation is simple and the hip functions recover well.