股骨粗隆间骨折的手术治疗  

Operative treatment of femoral intertrochanteric fractures

作　　者：王蕾[1] 陆宸照[1] 王亚梓[1] 张贝利[1] 张海生[1] 

机构地区：[1]上海第二医科大学附属瑞金医院骨科,上海市伤骨科研究所,200025

出　　处：《上海医学》2005年第2期99-101,共3页Shanghai Medical Journal

摘　　要：目的通过回顾性分析粗隆间骨折的手术效果,评价应用动力髋螺钉(DHS)治疗股骨粗隆间骨折的临床疗效.方法我院1998年1月～2003年5月共手术治疗股骨粗隆间骨折182例,其中应用135°DHS治疗148例,95°动力髁螺钉(DCS)治疗8例,髓内钉治疗26例.患者平均年龄为68岁(21～87岁).结果平均随访2.5年,骨折平均愈合时间为3.2个月,完全负重时间为5.8个月.1例急性感染者最终死亡,1例慢性感染,这2例感染患者均使用DHS护翼钢板(TSP);1例髓内钉治疗患者骨折延迟愈合.仅30%年龄>70岁的患者恢复至术前的活动水平.结论 135°DHS是治疗复位后稳定性粗隆间骨折的较好选择(31-A1,A2.1,A2.2),95°DCS和股骨Ⅱ型髓内钉是治疗不稳定性粗隆间骨折的较好选择(31-A2.3,A3).对粗隆间骨折同时合并股骨骨折的患者应选用Ⅱ型髓内钉.年龄是影响术后活动水平恢复程度的一大因素.Objective To evaluate the therapeutic effectiveness of dynamic hip screw (DHS) on intertrochanteric fractures.Methods Among 182 patients with intertrochanteric fractures, 148 cases were treated with 135° DHS; 8 with 95°DCS; 26 with intramedullary nail in our hospital from January 1998 to May 2003. The mean age of the patients was 68 years old (21～87 years).Results The duration of follow-up averaged 2.5 years including one case with acute and the other of chronic infections. These two cases were treated with DHS plus TSP (trochanteric stablization plate) and still another with intramedullary nail had delayed union. The mean duration of bone union was 3.2 months, the time for full weight-bearing averaged 5.8 months.Conclusion DHS is the better choice for the treatment of stable femoral intertrochanteric fractures. 95° DCS with intramedullary nail is the choice for treatment of reverse intertrochanteric fractures. Age is one of the factors affecting recovery of postoperative activity.

关 键 词：手术治疗 股骨粗隆间骨折 髓内钉 患者 DHS 年龄 愈合时间 DCS 恢复 TSP 

分 类 号：R687[医药卫生—骨科学]