骨折分型及外侧壁厚度对动力髋螺钉治疗外侧壁完整的股骨粗隆间骨折的影响  

The Effect of Gotfried's Classification and Lateral Femoral Wall Thickness on Intertrochanteric Fractures Treated by Dynamic Hip Screw

作　　者：季英楠[1] 阿良[1] 赵忠海[1] 邓纯博[1] 

机构地区：[1]沈阳医学院附属中心医院骨外二科,沈阳110024

出　　处：《中国医科大学学报》2015年第9期818-821,825,共5页Journal of China Medical University

摘　　要：目的 探讨骨折分型及外侧壁厚度对动力髋螺钉（DHS）治疗外侧壁完整的股骨粗隆间骨折的临床疗效。方法 回顾性分析2008年11月至2014年11月应用DHS治疗的72例股骨粗隆间骨折资料。按Gotfried分型分为外侧壁稳定型组（n=37,AO31A1型22例和A2.1型15例）和外侧壁危险型组（n=35,AO31A2.2型19例,AO31A2.3型16例）。术前测量X线片上的外侧壁厚度值,比较2组患者的手术时间、术中出血量、住院天数及术中、术后有无并发外侧壁骨折。采用老年髋部骨折功能恢复量表（FRS）对术后疗效进行评估。结果 外侧壁稳定型组手术时间、术中出血量、住院天数均低于外侧壁危险型组,差异有统计学意义。外侧壁稳定型组术中仅2例并发外侧壁骨折,术后X线提示2例并发外侧壁骨折,而外侧壁危险型组术中10例并发外侧壁骨折,术后X线提示3例并发外侧壁骨折。外侧壁稳定型组术前X线上测量外侧壁厚度为（28±6.2）mm,明显高于外侧壁危险型组[（22±4.9）mm],差异有统计学意义。54例患者获得随访,随访时间6-20个月,平均12个月。随访1年以上者50例,FRS评分：外侧壁稳定型组（76.5±7.9）分,外侧壁危险型组（64.3±4.8）分,差异有统计学意义。结论 外侧壁厚度和骨折分型是影响DHS治疗股骨粗隆间骨折中并发继发性外侧壁骨折的重要因素,直接影响手术效果及患者髋部功能恢复。Objective To evaluate the influence of Gotfried＇s classification and lateral femoral wall thickness on the efficacy of dynamic hip screw（DHS）treating intertrochanteric fractures with intact lateral femoral wall. Methods Data of 72 patients with intertrochanteric fractures treated by DHS from November 2008 to November 2014 were respectively analyzed. Patients were divided into two groups by Gotfried＇s classification,group A（n =37,stable lateral wall,including 22 patients of type AO31A1 and 15 patients of type A2.1）and group B（n =35,risky lateral wall,including 19 patients of type AO31A2.2 and 16 patients of type AO31A2.3）. The preoperative lateral femoral wall thickness was measured by X-ray. The two groups were compared for the operative time,operative blood loss,average length of stay,and secondary fracture of lateral femoral wall after operation. Clinical evaluation was made using the functional recovery scale（FRS）of hip fracture. Results The mean operative time,operative blood loss,average length of stay in group A were lower than in group B,with statistically significant differences. The secondary fracture of lateral femoral wall occurred in intraoperative 2 cases and postoperative 2 cases by X-ray in group A,and in intraoperative 10 cases and postoperative 3 cases by X-ray in group B. The mean postoperative lateral femoral wall thickness by X-ray was（28±6.2）mm in group A,significantly higher than（22±4.9）mm in group B,with statistically significant differences. Totally 54 cases were followed up for 6-20 months（mean,12 months）and 50 cases were followed up for over a year. The mean FRS score was（76.5±7.9）points in group A and（64.3±4.8）points in group B,with statistically significant differences. Conclusion The lateral femoral wall thickness and fracture classification were important factors for the secondary fracture of lateral femoral wall when treating intertrochanteric fractures using DHS and these factors directly influenced operative results and recovery of hip f

关 键 词：股骨粗隆间骨折 外侧壁 动力髋螺钉 

分 类 号：R683.42[医药卫生—骨科学]