不同类型股骨转子间骨折内固定选择及疗效分析.docVIP

不同类型股骨转子间骨折内固定选择及疗效分析 　　作者：袁士明1,史晓鹏1,王素春1,施海　　作者单位：1.张家港市中医医院骨伤科，江苏 张家港 215600; 2.苏州大学附属第二医院骨科，江苏 苏州 215004 　　【摘要】目的：探讨不同类型股骨转子间骨折的内固定选择，分析术后疗效。方法：回顾性分析88例股骨转子间骨折患者临床资料，其中髓外固定组(extramedullary fixation， EMF)41例，髓内固定组(intramedullary fixation， IMF)47例。结果： 88例均获随访，时间5～18个月。根据Sanders髋关节创伤后评分标准，髓外固定组末次评分及优良率：A1型 52.50±5.20和94.4%， A2型 48.31±4.38和87.5%，A3型 46.57±6.70和71.4%;髓内固定组末次评分及优良率：A1型48.00±6.02和81.8%，A2型 48.42±5.78和84.3%，A3型51.88±4.94和88.2%。在A1型骨折中，髓外固定组优良率和末次评分均高于髓内固定组，差异有统计学意义(P0.05);在A2型骨折中，两组间优良率和末次评分差异无统计学意义;在A3型骨折中，髓内固定组末次评分及优良率均高于髓外固定组，差异有统计学意义(P0.05)。结论： 对稳定性A1型首选髓外固定方法，对不稳定性A3型首选髓内固定方法，对不稳定性A2型要结合患者具体情况慎重选择内固定方法。每种内固定方法都有一定的并发症，可通过完善术中术后处理加以避免。 　　【关键词】 股骨转子间骨折; 骨折固定术; 髓外固定; 髓内固定 　　[Abstract]　Objective： To investigate the selection of proper internal fixation devices and analyze the clinical effect for different classification of trochanteric fracture. Methods： A total of 88 patients of different classification of trochanteric fracture were treated operatively with interal fixation， of which 41 patients were treated with extramedullary fixation(EMF) and 47 patients were treated with intramedullary fixation(IMF). Results： All of the 88 patients were followed up for 5-18 months. The last followed-up effect of each patient were evaluated according to Sanders criteria： A1 type of EMF group 52.50±5.20 and 94.4% of good rate， A2 type of EMF group was 48.31±4.38 and 87.5% of good rate， A3 type of EMF group 46.57±6.70 and 71.4% of good rate; A1 type of IMF group 48.00±6.02 and 81.8% of good rate， A2 type of IMF group 48.42±5.78 and 84.3% of good rate， A3 type of IMF group 51.88±4.94 and 88.2% of good rate. The difference of EMF and IMF among A1 type patients had more significant in the excellent rate and the last follow-up score of their hip function(P0.05)， EMF was much better than IMF. The difference of EMF and IMF among A2 type patients had no statistically significance(P0.05). The difference of EMF and IMF was among A3 type patients had more significan