小粗隆结构修复固定对股骨粗隆间骨折稳定性意义

目的探讨小粗隆结构修复固定对股骨粗隆间骨折稳定性的影响。方法 2004年5月至2008年6月收治股骨粗隆间粉碎骨折32例,按Evans分型,ⅢA型15例,ⅢB型10例,Ⅳ型7例。采用锁定钢板固定10例,DHS固定13例,解剖钢板固定9例。术中注重股骨小粗隆骨折的复位固定。结果所有病例随访13年,平均2.5年。按Harris髋关节功能评分,优10例,良16例,中3例,差3例,优良率81.3%。锁定钢板组后遗髋痛1例,无内固定松动、断裂、髋内翻、骨不连等并发症。DHS组1例粗隆部轴向压缩,螺钉穿透股骨头进入髋关节,2例髋内翻,1例骨不连。解剖钢板组5例髋内翻,3例髋痛,1例骨不连。结论小粗隆结构修复固定对股骨粗隆间骨折内固定术后的稳定性有显著加强作用。

Repairation of Lesser Trochanter for Stability of Femoral Intertrochanter Fracture

Objective To explore the effect on repairation of lesser trochanter for stability of femoral intertrochanter fracture.Methods From May 2004 to June 2008,32 cases with femoral intertrochanter fracture were operated.According to Evan type system,15 cases were in ⅢA type,10 cases were in ⅢB type.7 cases were in Ⅳ type.10 cases were fixed with locking plate.13 cases were fixed with DHS system.9 cases were fixed with anatomical plate.Lesser trochanter fracture was reduced and fixed.Results All patients were followed up for 1～3 years（averaged 2.5 years）.According to Harris score system,10 cases were excellent,16 cases were good,3 cases were moderate,3 cases were bad.Excellent and good rate was 81.3%.In locking plate group,hip pain was found in 1 cases,but no other application was found.In DHS group,screw penetrate femoral head into hip joint in 1 case.Coxa adducta was found in 2 cases.Bone non-union was found in 1 case.In anatomical plate group,coxa adducta was found in 5 cases,hip pain was found in 3 cases,bone non-union was found in 1 case.Conclusion Repairation of lesser trochanter is important for stability of femoral intertrochanter fracture.