股骨转子下骨折的髓内与髓外内固定比较研究  

A comparison between optional internal fixations of subtrochanteric fractures

作　　者：窦帮[1] 窦连荣 朱玮[1] 汪谦[1] 秦涛[1] 麻文谦[1] 

机构地区：[1]上海市松江区中心医院骨科,201600

出　　处：《中国骨与关节杂志》2015年第6期460-465,共6页Chinese Journal of Bone and Joint

摘　　要：目的比较股骨转子下骨折髓内、髓外固定系统的疗效,探讨各类型固定系统特点、影响骨折预后的因素及固定方式选择。方法 2009年8月至2014年6月,我院应用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)(A组)及(less invasive stabilization system,LISS)钢板倒置和股骨近端解剖锁定钢板(anatomic proximal femoral locking plate,APFLP)髓外固定组(B组)治疗股骨转子下骨折共95例,比较髓内、髓外组病例手术时间、术中出血量、骨折愈合时间、并发症及功能评分,并评价影响骨折预后因素。结果 A组手术时间为(75.68±15.35)min,术中出血量为(249.36±62.36)ml,愈合时间为(16.58±4.12)周,术后并发症3例,功能评分(90.04±4.71)分;B组手术时间为(75.23±15.74)min,术中出血量为(186.88±70.99)ml,愈合时间为(19.99±4.92)周,术后并发症2例,功能评分(90.17±3.81)分,两组在手术时间、术后并发症及功能评分上差异均无统计学意义(P>0.05),而术中出血量B组比A组少,骨折愈合时间A组比B组时间短,差异有统计学意义(P<0.01)。结论股骨转子下骨折的手术治疗,当以术后功能评分为评价标准时,髓内、髓外固定均适用,如内、外侧有较大骨块建议髓外固定。骨折类型与骨折预后相关,是影响骨折预后评分的因素,且骨折类型越复杂,预后越差,年龄、手术时间、术中出血量、临床愈合时间及是否髓内固定与骨折预后没有相关性。Objective To explore the signiifcance of optional internal ifxations of subtrochanteric fractures and prognostic factors by comparing the effects of various kinds of internal fixations.Methods Ninety-five cases were analyzed from August 2009 to June 2014. All patients were divided into intramedullary ifxation group （ proximal femoral nail antirotation, PFNA ） （ group A ）, extramedullary ifxation group （ group B ） which contains reversed less invasive stabilization system （ LISS ） and anatomic proximal femoral locking plate （ APFLP ）. Data of each group were collected for statistical analysis on the following aspects： operative time, blood loss, clinical healing time of fractures, post-operative restored functions and complications.Results Group A： the operative time was （ 75.68±15.35 ） min; blood loss during the operation was （ 249.36±62.36 ） ml; clinical healing time of fractures was （ 16.58±4.12 ） weeks; postoperative complications occurred in 3 cases; postoperative restored function score was （ 90.04±4.71 ） points. Group B： operative time was （ 75.23±15.74 ） min; blood loss during the operation was （ 186.88±70.99 ） ml; clinical healing time of fractures was （ 19.99±4.92 ） weeks; postoperative complications occurred in 2 cases; postoperative restored function score was （ 90.17±3.81 ） points. The differences of the operative time, postoperative restored function scores and complications between group A, B were of no statistical signiifcance （P〉0.05 ）. The differences of the blood loss between group A, B were of statistical signiifcance （P〈0.01 ）, the group B was less than the group A. The differences of the clinical healing time between group A, B were of statistical signiifcance （P〈0.01 ）, the group A was of shorter than the group B.Conclusions When the postoperative restored function is used as the evaluation standard, both of the two kinds of internal ifxation are applicable for subtrochanteric fractures. If the medial side or

关 键 词：股骨骨折 骨折 骨折固定术 髓内 骨折固定术 内 创伤和损伤 

分 类 号：R687.3[医药卫生—骨科学]