动力髁螺钉与动力髋螺钉治疗不稳定型.doc

硕士研究生论文 PAGE PAGE 28 动力髁螺钉与动力髋螺钉治疗不稳定型 股骨粗隆间骨折的对比研究 专 业： 中医骨伤科学 研究生： 安宏强 导 师： 陈联源 主任医师 摘 要 目的：对采用动力髁螺钉（Dynamic Condylar Screw，DCS）及动力髋螺钉（Dynamic Hip Screw，DHS）治疗不稳定型股骨粗隆间骨折的临床疗效进行比较研究，探讨不稳定型股骨粗隆间骨折的一种可靠内固定方法，并为进一步的生物力学研究提供临床依据。 方法：2004年1月～2005年3月，我院收治的不稳定型股骨粗隆间骨折病人60例，符合纳入及排除标准，用随机数字表法将其分为两组，每组各30例，一组采用动力髁螺钉（DCS组）手术内固定治疗，另一组采用动力髋螺钉（DHS组）手术治疗，对两组患者的一般资料，手术资料及术后功能恢复情况进行评估比较。 结果：两组病例均获得随访，两组在手术时间、术中出血量、切口长度、术中X线暴露次数、输血例数、术后离床时间及术后颈干角方面差异无统计学意义（P>0.05），术后1年Harris髋关节功能评分：DCS组为85.93±8.33分，DHS组为76.83±16.35分，P<0.01，两者比较差差异非常显著；术后并发症：DCS组1髋内翻病例，DHS组例出现髋内翻6例，出现内固定失效3例，两组并发症经x2检验，P<0.01，存在非常显著性差异。 结论：不稳定型股骨粗隆间选用DCS与DHS内固定在临床操作方面具有相似的手术侵袭性，但在术后功能恢复、术后并发症方面，选择DCS内固定优于DHS内固定。 关键词：股骨粗隆间骨折 不稳定型 DCS/内固定 DHS/内固定 手术 The Comparative study of the treatment of unstable intertrochanteric fracture of femur with dynamic condylar screw and dynamic hip screw Major: Orthopaedics and Traumatology of TCM Postgraduate: An Hongqiang Tutor: Prof. Chen lianyuan Abstract Objective: To compare the efficacy of the the treatment of unstable intertrochanteric fracture of femur with dynamic condylar screw(DCS) and dynamic hip screw(DHS), and to discuss the most idealistic immobilization methods to supply the clinical basis for the further biomechanics study. Methods: From January 2004 to March 2005, 60 cases of unstable intertrochanteric fracture of femur were treated in our hospital,and who all tallied with the criterion that should be subsumed or eliminated.We divided them into two groups randomly with the random number table. Then one group of 30 cases were treated by DCS,the other by DHS. The common conditions, operative procedures and postoperative recovery were evaluated and compared. Results: All the patients were all followed, and there is no significant difference(p>0.05) at the operation time ，hemorrhage，length of incision ，times of fluoroscopy ，the times of blood transfusion，times of departing from bed and the neck-shaft angle. Harris hip score of one year after operation: DCS group wa