辅助钢板与钢丝加固髓内钉治疗不稳定股骨转子部骨折的比较

目的]比较股骨近端髓内钉辅助股骨近端外侧锁定钢板与环扎钢丝内固定治疗不稳定股骨转子部骨折的临床疗效。方法]回顾分析本院于2015年3月~2017年1月收治的83例不稳定性股骨转子部骨折行股骨近端髓内钉固定并辅助外侧壁固定手术患者的资料。根据辅助固定方法不同分为钢板组39例和钢丝组44例。比较两组患者临床效果。结果]两组手术均顺利完成。钢板组手术时间显著长于钢丝组(P<0.05),两组患者在平均失血量、平均住院天数的差异无统计学意义(P>0.05),钢板组平均住院费用显著高于钢丝组(P<0.05)。随访12~24个月,平均(16.81±2.92)个月。钢板组平均完全负重时间显著早于钢丝组(P<0.05)。随时间延长,两组患者Harris评分显著增加(P<0.05);术后3个月钢板组的Harris评分显著高于钢丝组(P<0.05),至术后6、12个月时,钢板组的Harris评分仍高于钢丝组,但差异无统计学意义(P>0.05)。影像评估方面,钢板组骨折复位质量优秀率为71.79%,钢丝组为45.45%,差异有统计学意义(P<0.05)。钢板组骨折愈合时间显著早于钢丝组(P<0.05)。末次随访时两组患者颈干角差异无统计学意义(P>0.05)。至末次随访时,钢板组内固定松动2例,髋内翻2例;钢丝组股骨头坏死1例,髋内翻3例。结论]对不稳定性转子部骨折髓内钉辅助固定,钢丝环扎手术时间短、费用相对低。锁定钢板则有助于缩短完全负重及骨折愈合时间,并早期改善髋关节功能,骨折复位质量相对好。

Plate versus cerclage wire enhanced proximal femoral intramedullary nail for unstable femoral trochanteric fractures

Objective]To compare the clinical outcomes of unstable femoral trochanteric fracture treated by proximal femo?ral intramedullary nail enhanced with lateral locking plate versus cerclage steel wire.Methods]A retrospective study was done on 83 patients who received open reduction and internal fixation with proximal femoral intramedullary nail combined lateral en?hanced fixations for unstable femoral trochanteric fractures from March 2015 to January2017 in our hospital.Of them,39 pa?tients received the lateral enhanced fixation with locking plate,while the remaining 44 patients had cerclage wire as additional fixation.The clinical data were compared between the two groups.Results]All the patients had surgical procedures performed smoothly.Although the plate group spent significantly longer operation time,and significantly higher hospitalization expenses than the wire group(P<0.05),no statistically significant differences in intraoperative blood loss and hospital stay were proved between them(P>0.05).The follow-up period lasted for 12~24 months with an average of(16.81±2.92).The plate group re?turned to full-weight bearing significantly earlier than the wire group(P<0.05).The Harris score significantly increased in both groups over time postoperatively(P<0.05).The plate group got higher Harris score than the wire group,which was statistically significant at 3 months(P<0.05),whereas it became insignificant at 6 and 12 months postoperatively(P>0.05).Regarding to ra?diographic assessment,the excellent rate of fracture reduction proved of 71.79%in the plate group,while 45.45%in the wire group,which was statistically significant(P<0.05).In addi?tion,fracture healing achieved significantly earlier in the plate group than the wire group(P<0.05),nevertheless no a statistically significant difference was noted in neck-shaft angle at the latest follow between them(P>0.05).To the latest follow up,2 case of implant loosening and 2 case of coxa varus in the plate group,while 1 case of femoral head necrosis and 3 cases of coxa varus in the wire group were revealed by radiographs.Conclusion]The cerclage wire has benefits of saving time and cost in operation,however,the locking plate takes advantages of improving fracture reduction quality,shortening time to full weight bearing and fracture healing,and improving hip function recovery as the lateral additional fixations to proximal femoral intramedullary nail for unstable intertrochanteric fractures.