摘要
目的比较动力髋螺钉(DHS)在治疗不稳定股骨转子间骨折中采用固定小转子和不固定小转子两种方法对疗效的影响。方法DHS治疗45例不稳定股骨转子间骨折患者,按Evans-Jensen分类:ⅡB型(三部分骨折,小转子骨折)32例,Ⅲ型(四部分骨折,大、小转子都骨折)13例。按AO推荐方法安装DHS,小转子固定17例,小转子未固定28例。比较两种治疗方法的手术时间、术中出血量、术后引流量、骨折临床愈合时间和术后1周、6个月、2年的患侧股骨颈干角以及术后2年Harris髋关节功能评分等数据。结果45例均获2年随访。小转子固定组与未固定组在术后引流量、术后6个月和2年髋内翻发生率、Harris髋关节功能评分等方面差异无统计学意义(P>0.05);小转子固定组手术时间以及术中出血量均高于未固定组(P<0.05);而小转子固定组的骨折临床愈合时间低于未固定组(P<0.05)。结论对于不稳定的ⅡB型和Ⅲ型股骨转子间骨折,DHS系统无论修复或是不修复股骨内侧弓(固定小转子),都无法避免在远期髋内翻畸形有相似的发生率。而小转子不固定因为可以减少手术时间和术中出血,增加了手术的安全性,是相对可行的方法。
Objective To determine the effect of restoring femoral posteromedial cortical contact in unstable intertrochanteric hip fracture treated with dynamic hip screw（DHS） fixation.Methods 45 patients with unstable intertrochanteric hip fracture were fixed with DHS and received 2-year follow-up.According to the Evans classification,there were 32 cases of type ⅡB,13 cases of type Ⅲ fractures.The lesser trochanter was fixed with wire or screw in randomized 17 cases（lesser trochanter fix Group）.28 cases were treated without lesser trochanter reduction and fixation（lesser trochanter abandon Group）.The intraoperative time,intraoperative blood loss,postoperative drainage volume,clinical healing time,collodiaphyseal angle in postoperative one week,six months and two years,and Harris hip score in postoperative two years were observed.Results There was no significant difference in postoperative drainage volume,coxa vara rate in six months or two years and Harris hip score in postoperative two years between the two groups（P0.05）.The average intraoperative time and intraoperative blood loss in lesser trochanter fix Group were more than those in lesser trochanter abandon Group（P0.05）.The average clinical healing time in lesser trochanter fix Group was less than lesser trochanter abandon Group（P0.05）.Conclusions Although the displaced lesser trochanter can be fixed for the unstable intertrochanteric hip fracture with DHS fixation,a similar long-term coxa vara deformity incidence can not be avoided.Abandoning lesser trochanter reduction would be safer due to the less intraoperative time and blood loss.
出处
《临床骨科杂志》
2010年第2期157-159,共3页
Journal of Clinical Orthopaedics
关键词
股骨骨折
动力髋螺钉
小转子
骨折固定术
内
femoral fractures
dynamic hip screw
lesser trochanter
fracture fixation
internal
