背景：股骨转子间骨折内固定治疗的方法有很多，选择髓内还是髓外一直都存在争议，有研究认为就生物力学而言，髓内固定较髓外固定更加具有优势，那么高龄 Evans Ⅴ型转子间骨折是否也是髓内固定更好一些呢？ 目的：比较髓内与髓外内固定治疗高龄Evans Ⅴ型股骨转子间骨折的临床疗效。 方法：选择2010年12月至2013年12月在武警沈阳总队医院骨科进行治疗的高龄Evans Ⅴ型转子间骨折患者47例，分别采用联合加压交锁髓内钉系统及动力髋螺钉系统髓外内固定方式置入治疗。 结果与结论：动力髋螺钉组平均随访12个月，加压交锁髓内钉组平均随访10个月。随访期内2组均达骨性愈合。置入内固定治疗后动力髋螺钉组平均手术时间、术中出血量均少于交锁髓内钉组(P<0.05)；但在骨折愈合时间上抗旋髓内钉组明显短于动力髋螺钉组，且Harris评分显示交锁髓内钉组患者髋关节功能好于动力髋螺钉组(P <0.05)。髓外组主钉松动退出1例，钢板断裂1例；髓内组1例内固定螺钉松动1例。提示2种内固定治疗转子间骨折均可达到良好的治疗效果，但对于短期内高龄Evans Ⅴ型转子间骨折，加压交锁髓内钉系统髓内钉固定可使患者在不进行关节置换的前提下早期负重活动，髋关节功能效果更好。%BACKGROUND:There are many methods of internal fixation to treat intertrochanteric fractures. Intramedul ary or extramedul ary fixation remains controversial. As for biomechanics, intramedul ary fixation has more advantages compared with extramedul ary fixation. Whether intramedul ary fixation is better for treatment of Evans V type intertrochanteric fracture in the elderly? OBJECTIVE:To compare the clinical effects of intramedul ary or extramedul ary fixation for the treatment of Evans V type intertrochanteric fracture in the elderly. METHODA total of 47 patients with Evans V type intertrochanteric fracture in the elderly from Department of Orthopedics, Shenyang People’s Armed Police Corps Hospital from December 2010 to December 2013 were selected. They were separately subjected to compression interlocking intramedul ary nail system and dynamic hip screw system extramedul ary fixation. RESULTS AND CONCLUSION:Patients in the dynamic hip screw group were averagely fol owed up for 12 months, and those in the compression interlocking intramedul ary nail group were averagely fol owed up for 10 months. Both groups reached bone healing during fol ow-up. After fixation, average operation time and intraoperative blood loss were less in the dynamic hip screw group than in the interlocking intramedul ary nail group (P<0.05). However, fracture healing time was significantly shorter in the anti-spin intramedul ary nail group than in the dynamic hip screw group. Moreover, Harris scores revealed that hip joint function was better in the interlocking intramedul ary nail group than in the dynamic hip screw group (P<0.05). In the extramedul ary group, nail loose exit was detected in one case, plate breakage in one case. In the intramedul ary group, screw loose was detected in one case. Results suggested that two kinds of fixation for treating intertrochanteric fracture achieved good therapeutic effects. However, for Evans V intertrochanteric fractures in a short period, compression interlocking intramedul ary nail fixation can make patients do weight-loading activities earlier before joint replacement, and hip joint function effects are better.
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