标题：不同内固定方法在绝经后股骨转子间骨折患者中的应用

      作者：柏 冰 1，侯志勇 2
    （1.河北省临西县人民医院骨科，河北 邢台 054900；
2.河北医科大学第三医院创伤急救中心，河北 石家庄 050051）

      卷次： 2014年25卷13期

      【摘要】 目的 探讨不同内固定方法在绝经后股骨转子间骨折患者中的应用效果，为其临床治疗提供可参
考依据。方法 共纳入 90例入住我院骨科的绝经后股骨转子间骨折患者，采用随机数字法平均分为三组各 30
例，分别给予动力髋螺钉(A组)、股骨近端髓内钉(B组)及Gamma钉(C组)内固定治疗，观察三组患者的手术时间、
住院时间及并发症等，并随访 6个月评价患者的临床疗效。结果 A组、B组和C组的优良率分别为 90.00%，
96.67%，93.33%，Harris评分分别为(79.24±2.13)分、(82.42±2.64)分、(79.23±2.15)分，三组的优良率和Harris评分比
较差异均无统计学意义（P>0.05）。A组的手术时间为(101.24±6.13) min、术中出血量为(521.3±191.11) ml，明显高
于B组的(82.42±6.64) min和(319.4±142.02) ml，C组的(90.23±6.15) min和(321.3±131.12) ml，差异有统计学意义
(P<0.05)；A组、B组和C组的住院时间分别为(15.33±2.11) d、(15.04±1.93) d、(14.63±2.21) d，骨折愈合时间分别为
(12.02±2.51)周、(11.22±2.21)周、(11.13±2.13)周，三组的住院时间和骨折愈合时间比较差异均无统计学意义
(P>0.05)。A组发生髓内翻、内固定松动等并发症的例数最多，其次为C组，B组并发症的发生最少。结论 在治
疗绝经后股骨颈骨折的内固定方法中，股骨近端髓内钉内固定的总体疗效好于动力髋螺钉内固定的疗效，值得
临床推广应用。

      【关键词】 股骨转子间骨折；骨折；内固定；临床疗效

      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2014）13—1921—03


Clinical application of different internal fixations in the treatment of postmenstrual patients with
intertrochanteric fracture.
BAI Bing 1, HOU Zhi-yong 2. 1. Department of Orthopedics, Linxi People's Hospital, Xingtai
054900, Hebei, CHINA; 2. Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang
050051, Hebei, CHINA

【Abstract】 Objective To observe and compare the clinical curative effect of difierent intemaI flxations in the
treatment of postmenopausal patients with intertrochanteric fracture. Methods Ninety patients with postmenopausal in-
tertrochanteric femoral fracture admitted to our hospital were selected and randomly divided into three groups. Different
internal fixation methods were used in these patients, including dynamic hip screw for group A with 30 cases, proximal
femoral nail for group B with 30 cases, and gamma nail for group C with 30 cases. The operation time, hospitalization
days and complications were recorded and compared among groups. Besides, 6 months follow-up were performed to
evaluate the clinical effects. Results The excellent & good rate in group A, group B, and group C were 90.00%，
96.67%, and 93.33%, respectively. And the Harris score were (79.24±2.13), (82.42±2.64), and (79.23±2.15), respective-
ly. There was no statistical difference in excellent & good rate and Harris score among the three groups (P>0.05). Sur-
gery time in group A was (101.24±6.13) min, which was statistically significantly higher than that in group B and
group C [(82.42±6.64) min and (90.23±6.15) min], P< 0.05. Intraoperative blood loss in group A was statistically signif-
icantly higher than that in group B and group C [(521.3±191.11) ml vs (319.4±142.02) ml and (321.3±131.12) ml,
P<0.05]. The hospitalization days in group A, group B, and group C were (15.33 ± 2.11) d, (15.04 ± 1.93) d、and
(14.63 ± 2.21) d, respectively, with no statistical differences. And the time of fracture healing were (12.02 ± 2.51)
weeks, (11.22±2.21) weeks, and (11.13±2.13) weeks, respectively, with no statistical differences. The number of cas-
es complicated with pronation and internal fixation loosening in group A, group C and group B were in descending
order. Conclusion Compared with dynamic hip screw, proximal femoral nail internal fixation is safer and more reli-
able for treating postmenopausal patients with femoral inntertrochanteric fractures, which should be recommended in
clinical application.