三种内固定法治疗股骨粗隆间骨折的疗效评价

摘要

目的 评价角钢板、动力髋螺钉、锁定钢板三种内固定法治疗股骨粗隆间不稳定型骨折的疗效,探讨最佳手术治疗方法.方法 入选股骨粗隆间不稳定型骨折102例,按随机数字法分组,分别采用角钢板(A组,n=30)、动力髋螺钉(B组,n=38)和锁定钢板(C组,n=34)内固定治疗,治疗后对其疗效及并发症进行分析.按Sander标准进行疗效评分.结果 术后随访6个月至2年,平均10个月.术后6个月,B、C组术后功能恢复较A组好,差异有统计学意义(P＜0.05).C组内固定失败率明显较A、B组低,B组明显较 A组低,差异均有统计学性意义(P＜0.05).髋内翻发生率,A组为20.0%,B组为13.2%,C组为8.8%,三组间比较差异有统计学意义(P＜0.05).结论 锁定钢板内固定系统是治疗股骨粗隆间不稳定型骨折较为理想的方法.%Objective To evaluate the efficacy of angled blade plate, dynamic hip screw, and locking plate in the treatment of unstable femoral intertrochanteric fracture to optimize the surgical procedure.Methods Patients with unstable femoral intertrochanteric fracture ( n = 102 ) were enrolled and randomly divided to three groups by internal fixation system, namely angled blade plate group ( group A,n=30 ),dynamic hip screw group ( group B,n =38 ),and locking plate ( group C,n= 34 ).The effectiveness and complications of treatment were analyzed.The efficacy was scored by using Sander's criteria.Results Patients were followed up for 6 mo to 2 yr, at the average of 10 mo.Six months following the surgery, the functional improvement was better in group B and group C than in group A ( P ＜ 0.05 ).The internal fixation failure was less frequent in group C than in group A and group B ( P ＜ 0.05 ) whilst it was less frequent in group B than in group A ( P ＜ 0.05 ).The incidence rates of coax valga were 20.0 ％ , 13.2 ％ , and 8.8 ％ ( P ＜ 0.05 ).Conclusion The internal fixation with locking plate system was preferred for the treatment of unstable intertrochanteric fracture.