重建交锁髓内钉和动力髋螺钉治疗股骨转子下长节段粉碎骨折的对比研究  

A comparative study of proximal femoral comminuted fractures treated by reconstructive nail and dynamic hip screw

作　　者：唐尚权[1] 杨述华[2] 李坚[1] 唐化政[1] 贺建新[1] 

机构地区：[1]三峡大学第三临床医学院葛洲坝中心医院骨科,湖北宜昌443002 [2]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中国矫形外科杂志》2007年第22期1695-1697,共3页Orthopedic Journal of China

摘　　要：[目的]对比分析股骨转子下长节段粉碎性骨折重建交锁髓内钉（重建钉）内固定和动力髋螺钉（DHS）内固定的手术时间、出血量、并发症、下地负重时间、骨折愈合时间及临床疗效，寻求其中比较理想的一种内固定方法。[方法]回顾性分析2001年1月-2006年1月本院手术治疗的股骨转子下长节段粉碎性骨折患者27例，将27例按不同的内固定方法分为2组，其中DHS内固定组（A组）11例，男9例，女2例，平均38．75±6．25岁；重建钉内固定组（B组）16例，男14例，女2例，平均36．80±4．54岁；对2组手术时间、出血量、并发症、下地负重时间、骨折愈合时间及疗效评定方面进行对比分析。[结果]随访12-28个月，平均14．71个月，结果发现股骨转子下长节段粉碎性骨折2种内固定方法在手术时间（t=1．78，P〉0．05）、出血量（t=1．96，P〉0．05）、并发症（Fisher精确概率检验P=0．38）和疗效评定方面（Fisher精确概率检验P=0．50）无显著性差异；在下地负重时间（t=3．01，P〈0．05）和骨折愈合时间（t=2．71，P〈0．05）方面有显著性差异，重建钉较DHS短。[结论]对于股骨转子下长节段粉碎性骨折的治疗，重建交锁髓内钉内固定较动力髋螺钉更为理想。[ Objective] To find out a better internal fixation methods of proximal femoral comminuted fracture by compared analysis operation time, blood loss,complications, the time of bear partial burden, the time of union and the therapeutic effect of the reconstructive interlock intramedullary nail and dynamic hip screw. [ Method] Retrospective analyzed surgically treated 27 cases proximal femoral comminuted fractures from January 2001 to January 2006. They were divided into 2 groups with different internal fixation method： 11 cases of them （Group A ） were treated by dynamic hip screw, there were 9 males,2 females,with an average age of 38.75 ± 6.25 ; 16 cases （ Group B） were treated by reconstructive interlock intramedullary nail, there were 14 males ,2 females ,with an average age of 36.80±4.54 . The results were evaluated by operation time, blood loss, complications, the time of bear partial burden, the time of union and the therapeutic effect of two groups. [ Result] The follow - up time were 12 -28 months with an average of 14.71 months. No significant difference were found in associated with operation time（t = 1.78, P 〉 0.05）, blood loss （ t = 1.96,P 〉 0. 05 ）, complications （ Fisher＇s exact probabilities in 2 ＊ 2 table P = 0.38 ） and the therapeutic effect （ Fisher＇s exact probabilities in 2 ＊ 2 table P =0.50） between two groups. A significant difference were found in associated with the time of bear partial burden （ t = 3.01, P 〈 0. 05 ） and the time of union （ t = 2. 71, P 〈 0. 05 ）, there is less time of bear partial burden and the time of union in group B than group A. [ Conclusion] Reconstructive interlock intramedullary nail fixation is a better method for proximal femoral comminuted fracture than dynamic hip screw.

关 键 词：股骨 骨折内固定术 重建交锁髓内钉 动力髋螺钉 

分 类 号：R687.3[医药卫生—骨科学]