摘要
目的比较髓内钉与动力髋螺钉（DHS）固定治疗股骨转子间骨折术后髋部外展功能的恢复情况。方法回顾性分析2008年1月至2015年12月收治的310例股骨转子间骨折患者资料。根据治疗方式不同分为2组：髓内钉组198例，男71例，女127例；平均年龄为（74．7±5．6）岁；骨折AO分型：31-A1型50例，31-A2型134例，31-A3型14例；采用髓内钉固定。DHS组112例，男35例，女77例；平均年龄为（74．1±6．7）岁；骨折AO分型：31-A1型24例，31-A2型78例，31-A3型10例；采用DHS固定。比较2组患者的下地负重时间及单腿站立时间、步态及骨盆倾斜情况、髋关节主动外展范围及肌力、末次随访时髋关节功能等。结果284例患者术后获1．5-8．5年（平均3．6年）随访，死亡26例。髓内钉组患者的下地负重时间[（37．6±4．9）d]和单腿站立时间[（60．1±9．5）d]显著早于DHS组患者[（53．0±8．4）、（71．0±12．0）d]，步态正常和骨盆未倾斜的患者例数（171、179例）显著多于DHS组（67、85例），外展肌力[（62．3±4．4）N·m]显著大于DHS组患者[（56．6±3．3）N·m]，髋关节主动外展范围也显著优于DHS组患者，差异均有统计学意义（P〈0．05）。末次随访时髓内钉组与DHS组患者髋关节功能优良率分别为91．4％、84．5％，差异无统计学意义（P〉0．05）。结论与DHS比较，髓内钉固定股骨转子间骨折对患者术后髋部外展功能影响小，患者功能恢复和生活质量改善更快。
Objective To compare intramedullary nail （IN） and dynamic hip screw （DHS） re- garding their effects on hip abduction following fixation of intertrochanteric fractures. Methods From January 2008 to December 2015, 310 patients with intertrochanteric fracture were treated at our department. They were divided into 2 groups depending on the manner of treatment. 198 patients （71 males and 127 fe- males） were subjected to intramedullary nailing, with an average age of 74. 7 ± 5.6 years; there were 50 cases of 31-A1, 134 ones of 31-A2 and 14 ones of 31-A3 according to the AO classification. 112 patients （35 males and 77 females） were subjected to dynamic hip screwing, with an average age of 74. 1 ± 6.7 years; there were 24 cases of 31-A1, 78 ones of 31-A2 and 10 ones of 31-A3. The 2 groups were compared in terms of time for weight-bearing ambulation and stand on one leg, gait, pelvic tilt, range of hip active abduction, muscle strength of the abductor and hip function at the final follow-up. Results Of this series, 284 patients were followed up for 1.5 to 8.5 years （average, 3.6 years） and 26 patients died. The IN group achieved signifi- cantly better outcomes in terms of time for weight-bearing ambulation （37.6 ± 4. 9 d）, time for stand on one leg （60. 1 ±9. 5 d）, cases of normal gait and normal pelvic tilt （171 and 179）, muscle strength of the abductor （62.3±4.4 N·m）, and range of hip active abduction than the DHS group （53.0 ± 8.4 d; 71.0 ± 12. 0 d; 67 and 85; 56.6 ± 3.3 N·m, respectively） （ P 〈 0. 05）. There was no significant difference between the 2 groups in the hip function at the final follow-up（91.4% versus 84.5% in the excellent and good rate）（ P 〉 0.05）. Conclusion Compared with dynamic hip screwing, intramedullary nailing has a limited effect on hip abduction so that the patients may benefit from quicker functional recovery and faster improvement in quality of life.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2017年第2期95-102,共8页
Chinese Journal of Orthopaedic Trauma
关键词
髋骨折
骨折固定术
内
骨钉
外展肌
Hip fractures
Fracture fixation, internal
Bone nails
Abductor
