摘要
目的比较髓内钉与髓外固定治疗不稳定型股骨转子下骨折的疗效。方法回顾性分析2005年1月至2011年8月期间收治且获得随访的65例不稳定型（Russell-Taylor 分型B型）股骨转子下骨折患者资料，男40例，女25例；年龄为32～87岁，平均53.4岁。根据内固定方式不同分为两组：髓内钉组34例，髓外内固定组31例（其中锁定加压钢板内固定治疗21例，动力髋螺钉内固定治疗10例）。记录并比较两组患者的手术时间、术中出血量、骨折复位质量、住院时间、骨折愈合时间及术后12个月髋关节Harris评分。结果65例患者术后获12～18个月（平均15.6个月（随访。髋内钉组患者的手术时间[（67.9±19. 0）min] 较髓外内固定组[（79.8±22.4）min]短，术中出血量[（112.6±63.4）mL]较髓外内固定组[（178.5±97.5）mL]少，骨折愈合时间[（21.0±6.5）周]较髓外内固定组[（28.0±8.7）周]短，术后12个月髋关节Harris评分[（83.4±8.1）分]较髓外内固定组[（79.2±7.4）分]高，差异均有统计学意义（P〈0.05）。但两组患者的骨折复位质量、住院时间比较差异均无统计学意义（P〉0.05）。2例患者出现骨不连，均为采用锁定加压钢板固定者，改为髓内钉固定后骨折愈合；2例患者出现畸形愈合，其中髓外内固定组1例，髓内钉组1例。结论髓内钉较髓外内固定治疗不稳定型股骨转子下骨折更有优势。
Objective To comparte the effectiveness of intramedullary nailing （IN） and extramedullary fixation （EF） in the treatment of unstable subtrochanteric fractures. Methods From January 2005 to August 2011, our department treated 65 patients with unstable subtrochanteric fracture（ Russell-Taylor type B ）. They were 40 men and 25 women, aged from 32 to 87 years （average, 53.4 years）. Of them , 34 were fixated with IN and 31 with EF [olcking compression plating （LCP） used in 21 cases and dynamic hip screwing （DHS） in 10 cases]. The operation time, intraoperative blood loss, reduction quality, hospital stay, fracture healing time and Harris scores of the hip at 12-month follow-up were recorded and compared between the 2 groups . Results The 65 patients obtained an average follow-up time of 15.6 months （range, 12 to 18 months）. Compared with the EF group, the IN group had significantly shorter operation time （67.9±19.0 minutes versus 79.8±22.4 minutes ）, significantly less intraoperative blood loss（112.6±63.4mL versus 178.5±97.5mL）, significantly shorter healing time （21.0±6.5 weeks 28.0±8.7 weeks）, and significantly higher Harris scores （83.4±8.1 points versus 79.2±7.4 points） （P〈0.05）, but there were no significant differences between the 2 groups in reduction quality or hospital stay （P〉0.05）. Nonunion occurred in 2 patients who had LCP but was cured after the LCP was changed into IN. Both the IN group and the EF group had one case of malunion. Conclusion Intramedullary nailing may be a better treatment for unstable subtrochanteric fractures than extramedullary fixation.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2013年第5期407-410,共4页
Chinese Journal of Orthopaedic Trauma
关键词
髋骨折
骨折固定术
内
骨钉
骨板
Hip fractures
Fracture fixation, internal
Bone nails
bone plates
