髓内固定和髓外固定在稳定型粗隆间骨折中的疗效比较.docVIP

精品论文 参考文献 髓内固定和髓外固定在稳定型粗隆间骨折中的疗效比较 王 恒 邓伟 弋石泉 殷勇 谢成 杨帆 尹乾斌 　　（绵阳市骨科医院髋关节科 四川 绵阳 621000） 　　【摘 要】目的：比较髓内固定和髓外固定治疗稳定型股骨粗隆间骨折的临床疗效。方法：2008年7月～2014年6月，我科共收治股骨粗隆间骨折674例，按改良Evans分类法其中I、II型（稳定型）共计198例，手术治疗164例，用髓内固定（PFNA）92例，髓外固定（DHS）72例。从手术切口长短、手术时间、手术中出血量、术后早期功能锻炼时间四个方面进行比较。结果：髓内固定术后优良率明显高于髓外固定组，两组比较差异有显著性(P＜0．05)。结论：治疗稳定性粗隆间骨折PFNA优于DHS，髓内固定是治疗稳定型股骨粗隆间骨折理想内固定物之一。 　　【关键词】股骨粗隆间骨折；髓内固定；髓外固定；临床疗效 　　【中图分类号】R687 【文献标识码】B 【文章编号】1003-5028（2015）6-0576-02 　　【Abstract】Objective：The purpose of this study was to compare the clinical efficacy of proximal femoral nail anti-rotation (PFNA) with dynamic hip screw (DHS) for the treatment of stable intertrochanteric fractures. Methods：From July 2008 to June 2014, 674 patients with intertrochanteric fractures were treated. According to the Evans classification, type II I (stable) 198 cases were classified. 164 patients stable intertrochanteric fractures were fixed with PFNA in 92 patients (PFNA group) and with DHS in 72 patients (DHS group). The data of incision length, operative time, blood loss, postoperative early functional exercise time were recorded and compared. Results：All incisions healed by first intention. The incision length, aoperation time, blood loss and postoperative early functional exercise time in PFNA group were significantly less than those in DHS group (P lt; 0.05). Conclusion：There are two surgical methods to treat stable intertrochanteric fracturest: PFNA and DHS, and each has advantages; for stable intertrochanteric fractures, PFNA treatment is one of ideal internal fixations for stable intertrochanteric fracture. 　　【Key words】stable intertrochanteric fracture; PFNA；DHS; treatment outcome 　　股骨粗隆间骨折(intertrochanteric fracture of the femur)好发于老年人，伴随我国逐渐进入老龄化社会，股骨粗隆间骨折的发病率呈上升趋势，对于不 稳定型的股骨粗隆间骨折，大量的临床应用及实验已表明髓内固定为首选治疗方法，但对于改良Evans分类法其中I、II型（稳定型）骨折，治疗方法及固定材料的使用尚无明确标准。因此，临床上髓内固定及髓外固定两种固定方法都在广泛使用，但疗效及预后有着很大的差异。随着现代外科的发展及微创理念的普及，越来越多的骨科医师倾向于髓内固定系统（如PFNA）, 相对于髓外固定系统（如DHS）而言，髓内固定具有中心性固定、力臂短、可闭合复位操作、干扰骨折断端较小，出