股骨粗隆间骨折的内固定治疗策略  

Surgical treatment with internal fixation for femoral intertrochanteric fractures

作　　者：王强[1] 董利军[1] 周茂生[1] 杨民[1] 朱劲松[1] 徐祝军[1] 

机构地区：[1]皖南医学院弋矶山医院骨科,安徽芜湖241000

出　　处：《重庆医学》2010年第9期1042-1044,共3页Chongqing medicine

摘　　要：目的探讨不同内固定物治疗股骨粗隆间骨折的临床效果。方法回顾性分析47例股骨粗隆间骨折,按照Evans-Jensen分型,Ⅰa 6例,Ⅰb 12例,Ⅱa 13例,Ⅱb 9例,Ⅲ4例,逆粗隆型3例。其中采用动力髋螺钉(DHS)内固定38例,Gamma钉9例。结果术后随访42例,骨折全部愈合,愈合时间7～13个月。术后并发症包括髋内翻3例,螺钉断裂1例,股骨头切割1例。按Harris髋关节功能评分标准,总优良率达到90.1%。结论Evans-JensenⅠa、Ⅰb和Ⅱa型稳定性股骨粗隆间骨折首选DHS内固定,Ⅱb及Ⅲ型以上的不稳定性股骨粗隆间骨折可选择髓内固定系统如Gamma钉。Objective To investigate the clinical effects of different surgical treatments for femoral intertrochateric fractures.Methods A total of 47 patients with femoral intertrochanteric fracture（6 cases of type Ⅰa,12 cases of type Ⅰb,13 cases of type Ⅱa,9 cases of type Ⅱb,4 cases of type Ⅲ,3 cases of type reverse oblique intertrochanteric fracture,according to Evans-Jensen classification）were retrospectively reviewed,of which 38 patiens were treated operatively with dynamic hipscrew（DHS）,9 patients were stabilized intramedullarily with Gamma nail.Results Of the 42 follow-up cases,all fractures were healed in a mean of 9.2 months（range：7-13 months）.During the follow-up,complications occurred in 5 cases.Three cases had coxavara.One case had screw breakage and cutting out occurred in 1 case.According to the Harris hip score,the excellent and good rate was 90.1%.Conclusion DHS is reliable to stabilize stable fractures as Evans-Jensen type I and Ⅱa.The intramedullary fixation such as Gamma nail for unstable intertrochanteric fractures Evans-Jensen type Ⅱb and Ⅲ is very encouraging.

关 键 词：骨折 股骨粗隆间 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]