大粗隆外侧壁的完整性与股骨粗隆间骨折疗效的关系  

Relationship between Integrity of the Lateral Wall and Clinical Outcome for the Treatment of Intertrochanteric Fractures

作　　者：郑晓勇[1] 任昕宇 赵东升[1] 马远征[1] 

机构地区：[1]解放军第309医院骨科 [2]解放军61081部队门诊部

出　　处：《实用骨科杂志》2013年第6期489-492,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨股骨大粗隆外侧壁的完整性与股骨粗隆间骨折疗效的关系。方法 2006年1月至2010年1月,随机选取46例不稳定型顺向股骨粗隆间骨折手术患者,其中男性20例,女性26例;年龄43～88岁,平均74.7岁。大粗隆外侧壁破坏者为19例,完整者为27例。外侧壁破坏组有17例采用股骨近端防旋髓内钉(proximal femo-ral nail antirotation,PFNA)固定,2例采用DHS固定。外侧壁完整组18例采用PFNA固定,9例采用DHS固定。疗效评定采用Harris髋关节功能评分。外侧壁的完整性与临床疗效之间的相关性采用Spearman等级相关分析。结果所有患者随访13.5～62个月,平均21.4个月。末次随访采用Harris髋关节功能评分,其中外侧壁破坏组优10例,良5例,中3例,差1例,优良率为78.9%;外侧壁完整组优19例,良5例,中3例,差0例,优良率为88.9%。Spearman等级相关结果提示外侧壁的完整性与临床疗效密切相关。结果股骨大粗隆外侧壁的完整性与临床疗效密切相关,术前评估应明确外侧壁的完整性,选择合适的内固定方法,术中应避免医源性的损伤。Objective To determine the relationship between integrity of the lateral wall and clinical outcome for the treatment of intertrochanteric fractures. Methods 46 consecutive patients with unstable pertrochanteric fracture were treated with DHS or PFNA between 2006 and 2010（20 men and 26 women,with mean age of 74.7 years）. 17 pa- tients treated with PFNA and 2 with DHS for the patients with fractured lateral wall versus 18 with PFNA and 9 with DHS for the patients with integrated lateral wall. Harris hip functional score was used to evaluate the clinical out- come. Spearman rank correlation method was employed to analyse the correlation between integrity of the lateral wall and clinical outcome. Results All patients have been followed for 21.4 months （13.5~ 62 months）. For Harris hip functional score, 15 patients in fractured lateral wall group（78.9~ ） got excellent result versus 24 patients in integrat- ed lateral wall group （88. 9 ~ ）. Integrity of the lateral wall was significantly related to clinical outcome （P~ 0.05）. Conclusion Integrity of lateral wall has close relationship with clinical outcome for treatment of intertrochanteric fractures. Preoperative evaluation should be made for the integrity of lateral. Appropriate method of fixation should be selected and fractures of lateral femoral wall intraoperatively should be avoid.

关 键 词：粗隆间骨折 外侧壁 防旋型股骨近端髓内钉 动力髋螺钉 

分 类 号：R683.42[医药卫生—骨科学]