髋动力螺钉与锁定钢板治疗不同年龄组股骨粗隆间骨折疗效比较

目的比较动力髋螺钉（DHS）和股骨近端解剖锁定钢板治疗不同年龄组股骨粗隆间骨折的临床效果。方法对2006年3月至2011年3月采用动力髋螺钉（DHS）54例和股骨近端解剖锁定钢板内固定42例股骨粗隆间骨折进行回顾性分析，两种内固定方法患者以65岁为标准分成两组，比较其疗效差异。结果患者平均随访15．5个月（11～26个月），65岁以下DHS内固定组愈合率90．47％，锁定钢板内固定组愈合率94．44％，两组间无统计学意义（P〉0．05）；65岁以上DHS内固定组愈合率69．70％，锁定钢板内固定组愈合率91．67％，两组间有统计学意义（P〈0．05）。按髋关节功能MerleDaubigne标准评价，65岁以下DHS内固定组优良率62．96％，锁定钢板内固定组为80．95％，两组间有统计学意义（P〈0．05）。结论无明显骨质疏松的粗隆间骨折，DHS和股骨近端解剖锁定接骨板均是内固定的理想选择。高龄患者伴有明显骨质疏松粗隆问骨折，股骨近端解剖锁定接骨板疗效明显优于DHS，可以减少术后并发症的发生。

Effects analysis of treatment for femoral intertrochanteric fracture with anatomical plate and dynamic hip screw

Objective To compare the effects of anatomic proximal femoral locking plate (ALP) and dynamic hip screw (DHS) in treatment for intertrochanteric femoral fracture. Methods From March 2006 to March 2011, 96 cases with anatomical plate internal fixation for femoral intertrochanteric fracture were divided into two groups (age-over-65 group and age-under-65 group) and treated by internal fixation with ALP (42 cases) and DHS (54 cases). The healing quality, quality of reduction, and position of the implants were investigated to compare the curative effects of the two types of internal fixation. Results 96 cases were followed up for 11-26 months, 15.5 months in average. In age- over- 65 group, the healing rate of DHS was 69.70%,while the healing rate of ALP was 91.67%, which was significantly different (P<0.05). In age- under- 65 group, there was no significant difference between the two types of fixation in the healing rate (P>0.05). According to Merle Daubigne score, in age-under-65 group the excellent and good rate of DHS was 62.96%, while the excellent and good rate of ALP was 80.95%. There was statistical significance in the data. Conclusions DHS and ALP both are good choices for patients without severe osteoporosis. But as for elderly patients of intertrochanteric femoral fracture with obvious osteoporosis, ALP will be a better choice for better curative effects and less complications.