解剖型锁定钢板及Gamma钉治疗伴有外侧壁骨折股骨转子间骨折的病例对照研究

发布时间：2018-05-14 10:41

本文选题：股骨 + 骨折　；参考：《中国骨伤》2016年06期

【摘要】：目的 :比较解剖型锁定钢板与Gamma钉治疗伴有外侧壁骨折的不稳定性转子间骨折的临床疗效。方法:回顾性分析2010年6月至2014年6月采用解剖型锁定钢板和Gamma钉内固定治疗伴有外侧壁骨折的不稳定性转子间骨折(AO 31A2.2-3.3)且随访超过12个月的患者44例。其中采用解剖型锁定钢板内固定治疗的患者16例,男6例,女10例;年龄32~83岁,平均56.5岁。采用Gamma钉内固定治疗的患者28例,男17例,女11例;年龄26~87岁,平均60.4岁。观察并比较两组患者的手术时间、术中透视次数、总失血量(术中+隐性失血)、住院天数,术后疗效采用PPMS(Parker Palmer mobility score,PPMS)及HSS(Harris hip score,HHS)髋关节功能评分标准进行评价。结果:所有患者获得随访,时间12~24个月,平均16.2个月。Gamma钉组手术时间低于解剖锁定钢板组;解剖锁定钢板组失血量(术中+隐性失血)及术中透视次数少于Gamma钉组;两组患者住院天数比较差异无统计学意义;术后首次完全负重时间解剖锁定钢板组较Gamma钉组延长;末次随访时Gamma钉组PPMS评分(7.50±1.78)与解剖锁定钢板组(6.82±1.38)比较差异无统计学意义(t=2.341,P=0.132);Gamma钉组HHS评分(83.25±11.18)与锁定钢板组(86.14±12.36)比较差异无统计学意义(t=1.923,P=0.243);Gamma钉术后内固定并发症发生率低于解剖型锁定钢板组。结论 :解剖型锁定钢板治疗伴有外侧壁骨折的不稳定性转子间骨折可避免外侧壁再次损伤,尤其对骨折严重粉碎、髓内钉操作困难患者,同Gamma钉相比术后髋关节功能无显著差异,但术后并发症发生率高于Gamma钉,不应强调过早负重。
[Abstract]:Objective: To compare the clinical efficacy of anatomic locking plate and Gamma nail in the treatment of unstable intertrochanteric fractures with lateral wall fracture. Methods: a retrospective analysis of the unstable intertrochanteric fracture (AO 31A2.2-3.3) with the lateral wall fracture (AO 31A2.2-3.3) with anatomic locking plate and Gamma nail internal fixation from June 2010 to June 2014 Of the 44 patients after 12 months, 16 cases were treated with anatomical locking plate internal fixation, 6 men and 10 women, aged 32~83 years, with an average of 56.5 years old. 28 cases, 17 men and 11 cases were treated with Gamma nail fixation. The age of 26~87 years was 60.4 years old. The time of operation, the frequency of intraoperative fluoroscopy, and total loss of blood were observed. Volume (intraoperative + recessive bleeding), hospitalization days, the postoperative curative effect was evaluated by PPMS (Parker Palmer mobility score, PPMS) and HSS (Harris hip score, HHS). Results: all patients were followed up for a month, the average time of 16.2 months was lower than the anatomic locking plate group; the anatomical locking plate was dissected. The amount of blood loss (intraoperative + recessive bleeding) and the number of intraoperative fluoroscopy were less than that of the Gamma nail group; there was no significant difference in the number of hospitalization days in the two groups; the first complete weight negative time after the operation was longer than that of the Gamma nail group; the PPMS score of the Gamma nail group at the last follow-up (7.50 + 1.78) and the anatomic locking plate group (6.82 + 1.38) had no difference. Statistical significance (t=2.341, P=0.132); HHS score of Gamma nail group (83.25 + 11.18) and locking plate group (86.14 + 12.36) had no statistically significant difference (t=1.923, P=0.243); the incidence of internal fixation complications after Gamma nail operation was lower than that of the anatomical locking plate group. Conclusion: dissection locking plate for the treatment of unstable interrotors with lateral wall fracture Fracture can prevent the lateral wall from re injury, especially to the severe comminution of the fracture. There is no significant difference in hip function between the patients with intramedullary nail operation and Gamma nail, but the incidence of postoperative complications is higher than that of Gamma nail, and the premature weight should not be emphasized.

【作者单位】：浙江中医药大学附属江南医院杭州市萧山中医院骨科八病区;
【分类号】：R687.3

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