股骨转子间骨折分型与内固定螺钉的选择

背景：股骨转子间骨折的固定治疗方法有髓内固定和髓外固定,各有优劣。目的：探讨动力髋螺钉与新一代股骨近端髓内钉治疗不同分型的股骨转子间骨折的疗效差异。方法：2010年7月至2011年12月收治84例股骨转子间骨折患者,骨折按Evans分型：Ⅰa型及Ⅰb型共43例患者进行动力髋螺钉内固定;Ⅰc型及Ⅰd型共41例患者进行股骨近端髓内钉内固定。结果与结论：84例患者均获得随访,平均随访时间11.6个月,所有患者均骨折愈合。两组患者骨折愈合时间,下床活动时间及末次随访Harris评分差异均无显著性意义（P〉0.05）。动力髋螺钉组末次随访Harris评分为（87.7±9.3）分,优良率83.7%;新一代股骨近端髓内钉组末次随访Harris评分为（85.9±8.6）分,优良率90.2%。两组末次随访Harris评分和优良率差异无显著性意义（P〉0.05）。证实,在股骨转子间骨折内固定的植入物选择时,EvansⅠa及Ⅰb型骨折者适合采用动力髋螺钉定,EvansⅠc及Ⅰd型骨折适合选择新一代股骨近端髓内钉,两种螺钉植入后疗效均显著,且效果相当。

Type of intertrochanteric fracture and choice of internal fixation screw

BACKGROUND：The intramedullary and extramedullary fixations are two main surgical treatment methods for intertrochanteric fractures,each method has the advantages and disadvantages.OBJECTIVE：To investigate the different effect of dynamic hip screw and the new generation of the femur proximal femoral nail（InterTan） in the treatment of different sub-type of intertrochanteric fractures.METHODS：A series of 84 cases of intertrochanteric fractures were fixed by dynamic hip screw and InterTan during July 2010 to December 2011.According to Evans classification,43 patients of type Ⅰa and type Ⅰb were treated with dynamic hip screw,and 41 patients of type Ⅰc and type Ⅰd were treated with InterTan nails.RESULTS AND CONCLUSION：Eighty-four patients were followed-up for an average of 11.6 months,all patients were fracture healing.There was no significant difference in healing time,get out of bed time and the last follow-up Harris hip score between two groups（P 0.05）.The last follow-up Harris hip score in the dynamic hip screw group was（87.7±9.3） points,and the excellent and good rate was 83.7%;The last follow-up Harris score in the InterTan group was（85.9±8.6） points,the excellent and good rate was 90.2%.There was no significant difference of last follow-up Harris hip score between two groups（P 0.05）.During the choice of internal fixation materials,patients with Evans type Ⅰa and type Ⅰb should be treated with dynamic hip screw,and the patients with Evans type Ⅰc and type Ⅰd should be treated with InterTan nail.Both dynamic hip screw and InterTan have a positive effect and the effect is similar.