目的 观察股骨转子间骨折手术中不同内固定方式的临床疗效.方法 选取2010年10月至2011年10月我院收治的160例股骨转子间骨折患者作为研究对象,随机将其分为四组,分别采用防旋股骨近端髓内钉(PFNA,A组)、股骨近端髓内钉(PFN,B组)、Gamma钉(C组)和动力髋螺钉(DHS,D组)的不同内固定方式进行手术治疗,每组各40例.临床随访,记录并比较各组患者的手术时间、术中出血量、骨折的愈合时间等.结果 A、B、C、D四组优良率分别为97.50％、95.00％、92.50％、90.00％,各组比较差异无统计学意义(P＞0.05).A、B两组相对于C、D两组,其手术时间少,术中出血量少,愈合时间短.D组与A、B两组在手术时间和术中出血量方面比较差异有统计学意义(P＜0.05).结论 PFNA、PFN、Gamma钉和DHS四种不同内固定方式治疗股骨转子间骨折效果均良好,其中PFNA和PFN手术创伤少、手术并发症少,安全、可靠,更适用于伴骨质疏松症的股骨转子间骨折患者的治疗.%Objective To observe and compare the clinical curative effect of different internal fixations in the treatment of intertrochanteric fracture. Methods One hundred and sixty patients diagnosed with intertrochanteric femoral fracture by surgical operation from October 2010 to October 2011 in our hospital were selected as research subjects. They were randomly divided into four groups by different internal fixation methods used, including proximal femoral nail antirotation (PFNA, group A), proximal femoral nail (PFN, group B), Gamma nail (group C) and dynam-rnic hip screw (DHS, group D), with 40 cases in each group. The operation time, intraoperative bleeding volume, fracture healing time were recorded and compareed between the four groups. Results The excellent and good rate of group A, group B, group C and group D was 97.50%, 95.00%, 92.50% and 90.00%, respectively, with no statistically significant difference between the four groups (P>0.05). Compared with group C and group D, the operation time, intraoperative bleeding volume, and fracture healing time were found to be less or shorter in group A and group B, with statistically significant difference between group D and group A or group B (P<0.05). Conclusion Internal fixation with PFNA, PFN, Gamma nail and DHS all has good effect in the treatment of intertrochanteric fractures, but PFNA and PFN result in less trauma and fewer complications, which is safer and more reliable for treating patients with femoral intertrochanteric fractures complicated with osteoporosis.
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