髓外和髓内系统治疗31-A2型股骨转子间骨折的比较分析  

A clinical study of extramedullary internal fixation system vs. intramedullary fixation system in the treatment of 31-A2 fractures

作　　者：沈海敏[1] 梁承伟[1] 朱越峰[1] 陈聪[1] 

机构地区：[1]复旦大学附属华东医院骨科,上海200041

出　　处：《中华创伤骨科杂志》2007年第5期419-422,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较髓外系统（动力髋螺钉、动力髁螺钉等）和髓内系统（Gamma钉、重建钉、股骨近端髓内钉等）治疗AO／ASIF分型31-A2型股骨转子间骨折的术中情况、术后并发症及疗效，并探讨是否需要复位和固定股骨近端后内侧骨皮质。方法2000年3月～2006年2月，分别采用髓外系统和髓内系统治疗并随访31-A2型骨折患者20例和29例。比较两组患者手术情况、术后并发症及功能恢复情况。结果髓外组手术时间、出血量和术后并发症均多于髓内组，差异有统计学意义（P〈0．01）。髓外组和髓内组优良率分别为85．0％和89．7％，差异无统计学意义（P〉0．05）。而对于股骨近端内后侧骨皮质连续性欠佳或内侧骨块移位较大的20例患者，分别采用加压螺纹钉固定和微创术式钛缆固定的髓外组和髓内组并发症极少且优良率较高。结论髓外系统和髓内系统治疗31-A2型股骨转子间骨折疗效差异无统计学意义。但与髓外系统相比，髓内系统可缩短手术时间、减少术中出血量及术后并发症。对于股骨近端后内侧骨皮质连续性欠佳或内侧骨块移位较大者，髓外系统应对后内侧骨块进行复位和固定。Objective To investigate whether it is necessary to reduce and fix the posteromedial cortex of the proximal femurs in the treatment of 31-A2 fractures （AO/ASIF classification） by comparing the extramedullary internal fixation system and intramedullary fixation system in terms of operative procedure, complication and postoperative functional restoration. Methods From March, 2000 to February, 2006, 49 patients with 31-A2 fractures were treated by the extramedullary internal fixation system （20） and intramedullary fixation system （29） in our department. The 2 groups were followed up for an average of 16.8 months and 15.6 months respectively. The operative procedures, complication incidences and therapeutic effects in the 2 groups were compared statistically. Results The mean operation time in the extramedullary system group was statistically longer than that in the intramedullary system group（ P 〈 0. 01 ） . The mean intraoperative blood loss in the former was statistically more than that in the latter （ P 〈 0.01 ）. The incidence of complications in the former was also significantly higher than that in the latter （ P 〈 0. 01） . There was no significant difference in the good to excellent rate between the 2 groups （85.0% vs. 89.7% ） （ P 〉 0. 05）. Few complications occurred and a high excellent rate was achieved in the 20 cases who had the compression screw fixation of the posteromedial cortex in the extramedullary fixation group and minimally invasive cable cerclage fixation of the posteromedial cortex in the intramedullary fixation group for their poor integrity of the posteromedial cortex or great displacement of posteromedial bone fragments. Conclusions There is no significant difference between the 2 operative methods in treatment of 31-A2 fractures as far as the therapeutic effect is concerned. The intramedullary system, however, may shorten the mean operation time, reduce the mean intraoperative blood loss and reduce the complication incidence. If the integrity of posterom

关 键 词：股骨骨折 骨折固定术 内 骨钉 

分 类 号：R686[医药卫生—骨科学]