加长Gamma 3型髓内钉与股骨近端锁定钢板治疗股骨转子下骨折的疗效对比  

Comparison of long Gamma 3 nail and proximal femur locking plate for the treatment of femoral subtrochanteric fractures

作　　者：韩雷[1] 胡云根[1] 汪灿锋 方伟利 金波[1] 许世超[1] HAN Lei;HU Yun-gen;WANG Can-feng;FANG Wei-li;JIN Bo;XU Shi-c hao(Department of Orthopaedics,Traditional Chinese Medical Hospital of Xiaoshan,Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine,Hangzhou 311201,Zhejiang,China)

机构地区：[1]浙江中医药大学附属江南医院萧山中医院骨科八病区,浙江杭州311201

出　　处：《中国骨伤》2019年第2期105-110,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:比较加长Gamma 3型髓内钉与股骨近端锁定钢板(proximal femur locking plate,PFLP)治疗股骨转子下骨折的临床疗效。方法:回顾性分析2010年1月至2017年1月治疗股骨转子下骨折且随访超过12个月的58例患者,采用加长Gamma 3型髓内钉治疗35例,其中男18例,女17例;年龄25～78(66.5±23.5)岁;摔伤18例,交通伤7例,高处坠落伤10例;受伤至手术时间2～9 d,平均4.8 d。采用PFLP固定治疗23例,其中男8例,女15例;年龄31～81(63.4±22.4)岁;摔伤12例,交通伤6例,高处坠落伤5例;受伤至手术时间2～12 d,平均5.2 d。观察并比较两组患者的手术时间、总失血量(术中+隐性失血)、住院天数、骨折愈合情况、并发症及髋关节功能。结果:51例获得随访,时间14～36个月,平均24.8个月。其中加长Gamma 3型髓内钉组31例,PFLP组20例。加长Gamma 3型髓内钉组总失血量(术中+隐性失血)高于PFLP组(P<0.05);两组患者手术时间、住院天数、并发症比较差异无统计学意义(P>0.05);术后骨折愈合时间加长Gamma 3型髓内钉组为(17.2±2.4)周与PFLP组(18.1±2.6)周比较差异无统计学意义(P>0.05);加长Gamma 3型髓内钉组术后首次完全负重时间早于PFLP组(P<0.05)。术后1年随访加长Gamma 3型髓内钉组Harris评分80.29±10.28与PFLP组76.49±12.28比较差异无统计学意义(P>0.05);两组患者均未发生深部感染、肺栓塞、骨不连等并发症;2例住院期间出现下肢深静脉血栓,予血管外科放置滤网治疗;术后4例出现肺部感染,经抗感染等治疗后治愈。结论:加长Gamma 3型髓内钉及PFLP均能有效治疗股骨转子下骨折,加长Gamma 3型髓内钉不适于髓腔过细、前弓过大患者,PFLP因偏心固定,术后不应强调过早负重。Objective:To compare clinical efficacy of long Gamma 3 nail and proximal femur locking plate(PFLP)in treating f emoral subtrochanteric fractures.Methods:From January 2010 to January 2017,clinical data of 58 patients with subtrochanteric fractures followed more than 12 months were retrospective analyzed.Among them,35 patients were treated with long Gamma 3 nail including 18 males and 17 females aged from 25 to 78 years old with an average of(66.5±23.5)years old;Causes of injury includedfallonthegroundin18 cases,traffic accidents in 7 cases,andfallfrom heightin10 cases.The other23 patients were treatedwith PFLP fixation including 8 males and 15 females aged from 31 to 81 years old with an average of(63.4±22.4)years old;Causes of injury included fall on the ground in 12 cases,traffic accidents in 6 cases,and fall from height in 5 cases.Operative time,blood loss(intraoperative and hidden blood loss),hospital stays,bone healing and complications were observed and compared.Harris hip score after 1-year following-up was used to evaluate postoperative clinical effect.Results:Fifty-one patients were followed up from 14 to 36 months with an average of 24.8 months,including 31 patients were treated with long Gamma 3 and 20 patients were treated with PFLP.Blood loss(intraoperative and hidden blood loss)in PFLP group was less than that of long Gamma 3 nail group(P<0.05).There was no significant in operative time,hospital stays and complications between two groups(P>0.05).There was no significant differences in healing time of fractures between long Gamma 3 nail group(17.2±2.4)weeks and PFLP group(18.1±2.6)weeks(P<0.05).At 1-year following-up,there was no significant differences in Harris hip score between long Gamma 3 nail group(80.29±10.28)and PFLP group(76.49±12.28)(P<0.05).No complications such as pulmonary embolism and nonunion occurred.Two patients were treated with fitler whose oc curred deep vein thrombosis.Postoperative pulmonary infection curred in 4 cases and was cured by anti-infection therapy.Conclusion:Both

关 键 词：股骨转子下骨折 骨折内固定 内 骨折固定术 髓内 

分 类 号：R687.3[医药卫生—骨科学]