DHS和ALP治疗股骨转子间骨折的临床研究
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摘要
股骨转子间骨折是骨科常见疾病之一,目前多主张手术治疗。临床应用动力髋螺钉(Dynamic Hip Screw, DHS)治疗股骨转子间稳定性骨折取得了良好的疗效,被认为是最好的选择之一；同样作为一种髓外偏心固定,股骨近端解剖锁定钢板(Anatomic proximal femur Locking Plate, ALP)近年在国内外得到广泛应用,但用其治疗股骨转子间骨折一直存在争议,相关的文献也是褒贬不一。
目的：
通过回顾性分析,对比分析动力髋螺钉与股骨近端解剖锁定钢板治疗稳定性股骨转子间骨折时的临床疗效,并观察后者在不稳定性股骨转子间骨折治疗中的疗效,以期为骨折内固定的选择及进一步的研究提供依据。
资料和方法：
通过中南大学湘雅二医院电子病历及影像记录系统检索出2009年11月至2012年11月住院的符合纳入标准的股骨转子间骨折病例,并获得有效随访45例。骨折按Evans分型,DHS固定的Ⅰ型、Ⅱ型骨折(DHS组)17例,ALP固定的Ⅰ型、Ⅱ型骨折(ALP-1组)13例,ALP固定的Ⅲ型、Ⅳ型及V型骨折(ALP-2组)15例。记录三组患者年龄、性别、受伤原因等基本资料,比较DHS组与ALP-1组,ALP-1组与ALP-2组之间住院时间、手术时长、伤口长度、术中失血量、术后引流量、术中术后并发症、骨折愈合时间、Harris髋关节功能等指标的差异。采用SPSS Statistics19.0对数据进行分析统计学分析。
结果：
1、三组患者在年龄、性别、受伤原因、骨折侧、麻醉分型、手术离受伤时间等方面无显著性差异。
2、DHS组与ALP-1组相比,在伤口长度、术中失血量、术后引流量、住院时间方面,并无显著性差异；而ALP-1组手术时长较DHS组要短,差异有显著性。
3、ALP-1组与ALP-2组相比,在住院时间上无显著性差异；ALP-2组伤口长度、手术时长较ALP-1组要长,术中失血量、术后引流量较ALP-1组要多,差异有显著性。
4、三组在术中、术后并发症方面无显著性差异。
5、三组患者术后骨折平均愈合时间比较无显著性差异。
6、髋关节功能Harris评分比较,DHS组与ALP-1组比较无显著性差异；ALP-1组要优于ALP-2组,差异有显著性。
结论：
1、ALP与DHS均为治疗稳定性股骨转子间骨折的良好选择。
2、ALP治疗不稳定性股骨转子间骨折,创伤较大,术后髋关节功能相对较差,且无确切循证依据,仍需谨慎使用。
Intertrochanteric fracture is one of the common orthopedic trauma, most people advocate surgery. Clinical application of dynamic hip screw (DHS) in the treatment of stable intertrochanteric fractures achieved good effect, is considered to be one of the best choice; As same as an extramedullary eccentric fixation, anatomic proximal femoral locking plate (ALP) has been widely used, but with its treatment of intertrochanteric fractures has been controversial.
Objective:
Through retrospective analysis of dynamic hip screw and anatomic proximal femoral locking plate in the treatment of stable intertrochanteric fractures, compare the clinical efficacy between the two fixation; observe and analyze the clinical effects of anatomic proximal femoral locking plate in the treatment of unstable intertrochanteric femoral fractures, in order to provide clinical evidence for selection of the proper internal fixation.
Method:
We retrieved the cases hospitalized in November2009to November2012, which met the inclusion criteria, through the Second Xiangya Hospital's medical records retrieval system and image recording system. We accessed to effective follow-up of45cases, including17cases of stable fracture fixed with DHS (DHS group),13cases of stable fracture fixed with ALP (ALP-1group) and ALP fixed unstable fracture (ALP-2group)15cases. Recorded their age, sex, cause of injury and other basic information, and hospital stays, operation time, the length of incision, intraoperative blood loss, postoperative drainage, intraoperative and postoperative complications, union time of fracture, Harris hip function and other indicators. SPSS Statistics19.0software was used for statistical analysis.
Results:
1、There was no significant difference among the three groups in age, sex distribution, cause of injury, fracture side, ASA anesthesia typing and the dates from injury to surgery;2、There was no significant difference in the length of operative incision, intraoperative blood loss, postoperative drainage and hospital stays between DHS group and ALP-1group, but the operation time in DHS group was longer than which in ALP-1group, the difference was significant statistically;3、The length of incision and operation time in ALP-2group were longer than which in ALP-1group, the intraoperative blood loss and postoperative drainage in ALP-2group were more than which in ALP-1group, there were significant difference statistically; while there were no significant in hospital stays between the two groups;4、There was no significant difference in intraoperative or postoperative complications among the three groups;5、The average union time of fracture in three groups were not significantly different statistically；6、As to the hip function measured by Harris hip scores, there were no significant difference between the group of DHS and ALP-1,while the hip function of ALP-1group was better than that of ALP-2group, there was significant difference statistically.
Conclusions:
1、In the treatment of stable intertrochanteric fracture, DHS and ALP fixation,which can get good efficacy and there is no clinical significant difference,are both good choice.
2、The ALP fixation with greater trauma and relatively poor postoperative hip function in the treatment of unstable intertrochanteric fractures, and there is no definite evidence-based basis, still need to be used with caution.
目的：
通过回顾性分析,对比分析动力髋螺钉与股骨近端解剖锁定钢板治疗稳定性股骨转子间骨折时的临床疗效,并观察后者在不稳定性股骨转子间骨折治疗中的疗效,以期为骨折内固定的选择及进一步的研究提供依据。
资料和方法：
通过中南大学湘雅二医院电子病历及影像记录系统检索出2009年11月至2012年11月住院的符合纳入标准的股骨转子间骨折病例,并获得有效随访45例。骨折按Evans分型,DHS固定的Ⅰ型、Ⅱ型骨折(DHS组)17例,ALP固定的Ⅰ型、Ⅱ型骨折(ALP-1组)13例,ALP固定的Ⅲ型、Ⅳ型及V型骨折(ALP-2组)15例。记录三组患者年龄、性别、受伤原因等基本资料,比较DHS组与ALP-1组,ALP-1组与ALP-2组之间住院时间、手术时长、伤口长度、术中失血量、术后引流量、术中术后并发症、骨折愈合时间、Harris髋关节功能等指标的差异。采用SPSS Statistics19.0对数据进行分析统计学分析。
结果：
1、三组患者在年龄、性别、受伤原因、骨折侧、麻醉分型、手术离受伤时间等方面无显著性差异。
2、DHS组与ALP-1组相比,在伤口长度、术中失血量、术后引流量、住院时间方面,并无显著性差异；而ALP-1组手术时长较DHS组要短,差异有显著性。
3、ALP-1组与ALP-2组相比,在住院时间上无显著性差异；ALP-2组伤口长度、手术时长较ALP-1组要长,术中失血量、术后引流量较ALP-1组要多,差异有显著性。
4、三组在术中、术后并发症方面无显著性差异。
5、三组患者术后骨折平均愈合时间比较无显著性差异。
6、髋关节功能Harris评分比较,DHS组与ALP-1组比较无显著性差异；ALP-1组要优于ALP-2组,差异有显著性。
结论：
1、ALP与DHS均为治疗稳定性股骨转子间骨折的良好选择。
2、ALP治疗不稳定性股骨转子间骨折,创伤较大,术后髋关节功能相对较差,且无确切循证依据,仍需谨慎使用。
Intertrochanteric fracture is one of the common orthopedic trauma, most people advocate surgery. Clinical application of dynamic hip screw (DHS) in the treatment of stable intertrochanteric fractures achieved good effect, is considered to be one of the best choice; As same as an extramedullary eccentric fixation, anatomic proximal femoral locking plate (ALP) has been widely used, but with its treatment of intertrochanteric fractures has been controversial.
Objective:
Through retrospective analysis of dynamic hip screw and anatomic proximal femoral locking plate in the treatment of stable intertrochanteric fractures, compare the clinical efficacy between the two fixation; observe and analyze the clinical effects of anatomic proximal femoral locking plate in the treatment of unstable intertrochanteric femoral fractures, in order to provide clinical evidence for selection of the proper internal fixation.
Method:
We retrieved the cases hospitalized in November2009to November2012, which met the inclusion criteria, through the Second Xiangya Hospital's medical records retrieval system and image recording system. We accessed to effective follow-up of45cases, including17cases of stable fracture fixed with DHS (DHS group),13cases of stable fracture fixed with ALP (ALP-1group) and ALP fixed unstable fracture (ALP-2group)15cases. Recorded their age, sex, cause of injury and other basic information, and hospital stays, operation time, the length of incision, intraoperative blood loss, postoperative drainage, intraoperative and postoperative complications, union time of fracture, Harris hip function and other indicators. SPSS Statistics19.0software was used for statistical analysis.
Results:
1、There was no significant difference among the three groups in age, sex distribution, cause of injury, fracture side, ASA anesthesia typing and the dates from injury to surgery;2、There was no significant difference in the length of operative incision, intraoperative blood loss, postoperative drainage and hospital stays between DHS group and ALP-1group, but the operation time in DHS group was longer than which in ALP-1group, the difference was significant statistically;3、The length of incision and operation time in ALP-2group were longer than which in ALP-1group, the intraoperative blood loss and postoperative drainage in ALP-2group were more than which in ALP-1group, there were significant difference statistically; while there were no significant in hospital stays between the two groups;4、There was no significant difference in intraoperative or postoperative complications among the three groups;5、The average union time of fracture in three groups were not significantly different statistically；6、As to the hip function measured by Harris hip scores, there were no significant difference between the group of DHS and ALP-1,while the hip function of ALP-1group was better than that of ALP-2group, there was significant difference statistically.
Conclusions:
1、In the treatment of stable intertrochanteric fracture, DHS and ALP fixation,which can get good efficacy and there is no clinical significant difference,are both good choice.
2、The ALP fixation with greater trauma and relatively poor postoperative hip function in the treatment of unstable intertrochanteric fractures, and there is no definite evidence-based basis, still need to be used with caution.
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