不同内固定手术方法治疗不稳定型股骨颈骨折的对照分析  

The control analysis of different internal fixation surgical methods in the treatment of unstable femoral neck fracture

作　　者：周军杰[1] 曹成福[1] 庞金辉[1] 陈贤奇[1] 高文武[1] 

机构地区：[1]上海中医药大学附属普陀医院骨科,200062

出　　处：《中国矫形外科杂志》2013年第2期136-139,共4页Orthopedic Journal of China

基　　金：上海市重点学科基金资助项目(编号:T0303);上海市教委科研项目(2011JW60)

摘　　要：[目的]评价不稳定型股骨颈骨折分别采用滑动式鹅头钉(DHS)和InterTAN髓内钉内固定的临床疗效。[方法]回顾性分析2007年2月～2011年2月,307例接受内固定手术治疗的股骨颈骨折患者,男189例,女118例;年龄38～69岁,平均(50.64±5.25)岁。股骨颈骨折分型按Pauwels分型:II型86例,III型221例。本研究病例损伤至手术时间2～5 d,平均(3.15±2.03)d。本组病例随机采用滑动式鹅头钉(DHS)或InterTAN髓内钉内固定,采用滑动式鹅头钉(DHS)136例,采用InterTAN髓内钉内固定171例。患者手术后经规范术后随访,临床髋关节功能按Harris评价标准。[结果]283例患者获得随访,随访时间11～32个月,平均(15.4±3.25)个月。Harris评分:DHS组从术前平均(13.52±3.06)分提高到末次随访时的平均(83.54±2.15)分;其中优65例,良48例,可17例,差6例,优良率为83.1%(113/136),差评中1例(0.74%)发生骨不连,3例(2.21%)发生髋内翻畸形,2例(1.47%)发生股骨头坏死。InterTAN组从术前平均(11.86±4.75)分提高到末次随访时的平均(91.75±3.62)分;其中优92例,良66例,可13例,优良率为92.4%(158/171),无骨折不愈合及髋内翻畸形、无髓内钉断裂。本研究中所有病例均无感染。[结论]应用InterTAN髓内钉内固定技术治疗不稳定型股骨颈骨折,手术创伤小,固定坚强,可早期活动,与DHS比较,具有较少的骨不连和髋内翻发生率,结果令人满意。[ Objective] To evaluate the clinical outcome of unstable femoral neck fracture treated by internal fixation of dynamic hip screw system（DHS） and the InterTAN intramedullary nail. [ Method] Retrospective analysis of 307 cases of femoral neck fractures treated by internal fixation （from February 2007 to February 2011 ） was made, including 189 males and 118 fe- males with an average age of 50. 64 ± 5.25 years （range,38 -69 years）. According to the Pauwels classification, there were 86 cases of type II,and 221 cases of type III. The interval between injury and surgery was 2 -5 days （average,3.15 ：t： 2. 03 days） All the cases were randomly treated by DHS or InterTAN intramedullary nail. All the cases were divided into two groups：the DHS group with 136 cases and the InterTAN group with 171 cases. Standard clinical evaluation utilizing the Harris hip score was used in this prospective study. [ Result ] Actually 283 cases were followed up with an average of 15.4 ＋ 3.25 months （range, 11 -32 months）. In the DHS group：the average Harris hip score improved from 13.52 ± 3.06 points preoperatively to 83.54 ± 2. 15 points at the last follow - up, including excellent results 65 cases, good 48 cases, fair 17 cases and poor 6 cases. There were one case （0. 74 % ） with non - union of fracture, three cases （ 2.21% ） with hip varus deformity and two cases （ 1.47 % ） with asep- tic necrosis of the femoral head among 6 bad cases in DHS group. In the InterTAN group ： the average Harris hip score improved from 11.86 ±4. 75 points preoperatively to 91.75 ＋3.62 points at the last follow - up,including excellent results 92 cases,good 66 cases ,fair 13 cases and no poor result. There was no case with non - union of fracture or hip varus deformity or nail breakage in InterTAN group. There was no infection in this research project. [ Conclusion] The InterTAN intramedullary nail used to treat unstable femoral neck fracture can provide good clinical results, with less bleeding, less trauma, ea

关 键 词：股骨近端 髋骨折 股骨颈骨折 分型 治疗方法 内固定手术 

分 类 号：R687.3[医药卫生—骨科学]