动力髋螺钉联合空心钉治疗A2型股骨粗隆间骨折  

DHS with cannulated screw for the treatment of type A2 intertrochanteric fracture

作　　者：张玺[1] 魏万富[1] 祝春霞[2] 张建国[1] 

机构地区：[1]天津市天津医院创伤骨科,300211 [2]天津市天津医院超声科,300211

出　　处：《中国矫形外科杂志》2014年第18期1661-1665,共5页Orthopedic Journal of China

摘　　要：[目的]比较动力髋螺钉（DHS）联合空心钉、单纯DHS及Gamma3髓内钉治疗A2型股骨粗隆间骨折的疗效,以探讨A2型骨折的最佳治疗方法。[方法]自2007年1月-2012年1月间本病区共手术治疗A2型股骨粗隆间骨折患者233例,其中采用DHS联合空心钉58例,采用单纯DHS者102例,Gamma3髓内钉73例,记录切口长度、手术时间、术中出血量、术后出血量、术中透视次数、住院费用、骨折愈合时间、并发症例数及髋关节Harris评分,计量资料进行方差分析,计数资料采用确切概率法进行分析。[结果]术后随访6-24个月,在切口长度方面,DHS联合空心钉组与其他两组比较差异存在统计学意义（P〈0.05）;住院费用方面,DHS联合空心钉组少于Gamma3髓内钉组（P〈0.05）;在骨折愈合和髋关节Harris评分方面,DHS联合空心钉组与单纯DHS组的差异存在统计学意义（P〈0.05）;在其他方面DHS联合空心钉与Gamma3髓内钉组二者差异无统计学意义（P〉0.05）;在并发症方面,三组间差异无统计学意义（P〉0.05）。[结论]DHS联合空心钉治疗A2型股骨粗隆间骨折是一种肯定和值得推荐的方法。[Objective] To compare the treatment effect of DHS combined with cannulated screw and with only DHS in type A2 intertrochanteric fracture,and to discuss the optimal operation method. [Method]From January 2007 to January 2012,two hundreds and thirty three patients with type A2 intertrochanteric fracture were operated in our department. Fifty-eight patients were treated with DHS combined with cannulated screw,one hundred and two patients were treated only with DHS,and seventy three patients were treated with Gamma3 intramedullary nail. The data of each group were collected for statistical analysis on the following aspects： incision length,operative time,intraoperative blood loss,posteroperative blood loss,intraoperative fluoroscopy exposures,cost in hospital,clinical healing time of fractures,posteroperative complications and Harris score. All data were delt with analysis of variance. The enumeration data were analyzed with Fisher＇s exact test.[Result]The follow- up time was from 6months to 24 months. The differences between group DHS combined with cannulated screw and other two groups existed statistical significance about the incision length（ P〈0. 05）. Group DHS combined with cannulated screw spent less than group Gamma3 in hospital（ P〈0. 05）. The difference between group DHS combined with cannulated screw and group of single DHS existed statistical significance about union and Harris＇ grade（ P〈0. 05）. However,there was no other obvious differences between group DHS combined with cannulated screw and Group Gamma3 （P〉0. 05）. There was no difference of statistical significance in other aspects among the three groups（ P〉0. 05）.[Conclusion]The DHS combined with cannulated screw is an effective and recommended choice for type A2 intertrochanteric fracture.

关 键 词：股骨粗隆间骨折 动力髋螺钉 空心钉 Gamma3髓內钉 

分 类 号：R687.3[医药卫生—骨科学]