Trigen髓内钉与动力髋螺钉治疗股骨转子间骨折合并同侧股骨颈骨折的临床疗效比较  

Comparison on clinical effects of Trigen intramedullary nails versus dynamic hip screws in treatment of intertrochanteric fractures combined with ipsilateral femoral neck fractures

作　　者：杨翔[1] 赵友明[1] 陈林[1] 叶聪聪[1] 王波[1] 

机构地区：[1]温州医科大学附属第二医院骨科,325000

出　　处：《中华创伤杂志》2014年第6期564-568,共5页Chinese Journal of Trauma

摘　　要：目的比较Trigen髓内钉与动力髋螺钉（dynamic hip screw，DHS）治疗股骨转子间骨折合并同侧股骨颈骨折的临床疗效。方法2005年6月-2011年4月分别采用DHS和Trigen髓内钉两种内固定方法治疗47例股骨转子间骨折合并同侧股骨颈骨折患者，41例获随访，时间20～90个月，平均45．6个月。其中男22例，女19例；年龄24—56岁，平均40．29岁。致伤原因：交通伤32例，高处坠落伤9例。合并颅脑外伤2例，尺桡骨远端骨折1例，同侧胫腓骨骨折1例。股骨转子间骨折按改良Evans分型：Ⅲ型12例，Ⅳ型18例，Ⅴ型11例；股骨颈骨折按照骨折部位分型：基底型24例，经颈型13例，头下型4例。根据内固定方法不同分为DHS组（20例）、Trigen髓内钉组（21例）。比较术后并发症、手术时间、术中出血量、术后住院时间、术后负重时间、骨折愈合时间，并参照Harris髋关节功能评分标准，对术后6个月时髋关节功能进行评定。结果两组在术后并发症、手术时间、术后住院时间、骨折愈合时间以及术后6个月Harris评分等方面差异均无统计学意义（P〉0．05）；DHS组术中出血量[（370．7±73．4）ml]、术后负重时间[（20．4±3．1）d]与Trigen髓内钉组[（173．0±55．8）ml、（14．9±1．5）d]比较，差异有统计学意义（P〈0．05）。结论Trigen髓内钉是股骨转子间骨折合并同侧股骨颈骨折比较适合的内固定物，当应用Trigen髓内钉出现困难时，可考虑选择DHS进行内固定。Objective To compare the clinical effects of Trigen intramedullary nailing and dynamic hip screw （DHS） fixation in treatment of intertroehanteric fractures combined with ipsilateral femo- ral neck fractures. Methods The study enrolled 41 patients followed up from 47 patients with intertrochanteric fractures combined with ipsilateral transcervical fractures treated with DHS or Trigen nails from June 2005 to April 2011. Period of follow-up was 20-90 months （mean, 45.6 months）. There were 22 males and 19 females aged at 24-56 years （mean, 40.29 years）. Injury was caused by traffic accidents in 32 patients and fall from height in 9. Associated injuries included craniocerebral trauma in 2 patients, distal radioulnar fracture in 1, and ipsilateral tibiofibular fracture in 1. According to the improved Evans classification of intertrochanterie fracture, there were 12 patients with type Ⅲ fractures, 18 with type Ⅳ, and Ⅱ patients with type Ⅴ. According to the sites of injury, femoral neck fracture were classified to basal type in 24 patients, transcervical type in 13, and sub-capital type in 4. The patients were randomly divided into DHS group （n = 20） and Trigen intramedullary nail group （n = 21 ）. Two groups were compared in aspects of postoperative complications, operation time, intraoperative blood loss, postoperative hospital stay, postoperative weight-bearing time, and fracture healing time. Besides, the hip joint function was assessed using Harris score at 6 months postoperatively. Results Apart from postoperative complications, operation time, postoperative hospital stay, fracture healing time, and Harris hip score, intraoperative blood loss [ （ 370.7 ±73.4） ml ] and postoperative weight-bearing time [ （20.4 ± 3.1 ） days ] in DHS group revealed statistical difference compared with Trigen intramedullary nail group[ （ 173.0 ±55.8 ）ml, （ 14.9±1.5 ） days,P 〈 0.05 ]. Conclusions Trigen intramedullary nailing system is a suitable internal fixator for intertrochanteric fr

关 键 词：髋骨折 骨折固定术 内 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]