动力髋结合转子稳定钢板与Gamma钉内固定治疗股骨转子间骨折的比较  

Dynamic hip screw combined with trochanter stabilizing plate versus Gamma nail fixation in repair of intertrochanteric fracture

作　　者：周强[1] 陆骅[1] 俞思明[1] 王占朝[1] 茅宇仑[1] 姚兵[1] 张天浩[1] 

机构地区：[1]上海交通大学医学院附属新华医院崇明分院,上海市202150

出　　处：《中国组织工程研究》2014年第9期1441-1446,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:股骨转子间骨折患者在早期积极有效的内固定治疗可以获得良好的疗效。目的:探讨动力髋螺钉+转子稳定钢板与Gamma钉置入内固定治疗EvansⅢB型、IV型股骨转子间骨折的比较。方法:选取上海交通大学医学院附属新华医院崇明分院2009年2月至2012年11月收治的67例EvansⅢB型、IV型股骨转子间骨折患者,其中动力髋螺钉+转子稳定钢板治疗28例,Gamma钉治疗39例。所有患者治疗后常规使用抗生素和功能锻炼。回顾性分析两组患者治疗时间、治疗中出血量、骨折愈合时间以及Harris髋关节功能评分。结果与结论:所有患者随访6-45个月,平均随访21个月。①动力髋螺钉+转子稳定钢板组出现感染1例,经换药半年后拔除内固定治愈,Gamma钉1例肥胖患者治疗后3周下床活动时再次受伤,出现远端锁钉处骨折,经更换长Gamma钉后愈合,Gamma钉组有4例患者因大转子固定欠稳定,卧床时间超过6周出现重症肺炎,经转内科治疗后治愈。②动力髋螺钉+转子稳定钢板组治疗后出现髋内翻畸形2例,Gamma钉组3例,所有患者骨折均愈合。③动力髋螺钉+转子稳定钢板组较Gamma钉组治疗时间更长,治疗中出血量明显增多(P<0.05),骨折愈合时间及Harris髋关节功能评分,两组比较差异无显著性意义(P>0.05)。动力髋螺钉+转子稳定钢板和Gamma钉均是治疗EvansⅢB型、IV型股骨转子间骨折的有效方法,选择合适的内固定物要根据骨折的稳定性、骨折愈合状况、骨质疏松程度等综合分析。BACKGROUND： Intertrochanteric fracture can obtain good curative effects after active effective internal fixation in early stage. OBJECTIVE： To compare dynamic hip screw ＋ trochanter stabilizing plate and Gamma nail fixation for treatment of Evans type I IIB and type IV intertrochanteric fracture. METHODS： A total of 67 patients with Evans type ⅢB and type IV intertrochanteric fracture, including 28 cases undergoing dynamic hip screw ＋ trochanter stabilizing plate and 39 cases undergoing Gamma nail, were selected from Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine fromFebruary 2009 to November 2012. All patients received antibiotics and functional exercises after treatment. Time of therapy, intraoperative bleeding amount, fracture healing time and Harris Hip Score were retrospectively analyzed in patients of both groups. RESULTS AND CONCLUSION： All patients were followed up for 6-45 months, averagely 21 months. （1） One patient affected infection in the dynamic hip screw ＋ trochanter stabilizing plate group. He was healed after fixation removal half a year after drug exchange. One obese patient experienced injury again during out-of-bed activity at 3 weeks after treatment in the Gamma nail group. Fracture appeared at distal end of lock pin, and healed after replaced by Gamma nail. Trochanteric stabilizing plate was unstable in four patients of the Gamma nail group. They affected severe pneumonia after over 6 weeks of lying in bed, and healed after treatment in the medical department （2） Coxa vara appeared in two cases of the dynamic hip screw ＋ trochanter stabilizing plate group, and three cases in the Gamma nail group. Fracture healing was achieved in all patients. （3） The time of therapy was longer, and intraoparative bleeding amount was significantly more in the dynamic hip screw ＋ trochanter stabilizing plate group compared with the Gamma nail group （P 〈 0.05）. No significant difference in healing time and Harris Hip Score w

关 键 词：植入物 骨植入物 动力髋螺钉 转子稳定钢板 GAMMA钉 Evans分型 股骨转子间骨折 不稳定转子间骨折 大转子粉碎骨折 大转子冠状面骨折 

分 类 号：R318[医药卫生—生物医学工程]