| 加长Gamma 3型髓内钉与股骨近端锁定钢板治疗股骨转子下骨折的疗效对比 |
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投稿时间：2018-08-10
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| 作者 | Author | 单位 | Address | E-Mail |
| 韩雷 |
HAN Lei |
浙江中医药大学附属江南医院 萧山中医院骨科八病区, 浙江 杭州 311201 |
Department of Orthopaedics, Traditional Chinese Medical Hospital of Xiaoshan, Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
hallen505@163.com |
| 胡云根 |
HU Yun-gen |
浙江中医药大学附属江南医院 萧山中医院骨科八病区, 浙江 杭州 311201 |
Department of Orthopaedics, Traditional Chinese Medical Hospital of Xiaoshan, Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 汪灿锋 |
WANG Can-feng |
浙江中医药大学附属江南医院 萧山中医院骨科八病区, 浙江 杭州 311201 |
Department of Orthopaedics, Traditional Chinese Medical Hospital of Xiaoshan, Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 方伟利 |
FANG Wei-li |
浙江中医药大学附属江南医院 萧山中医院骨科八病区, 浙江 杭州 311201 |
Department of Orthopaedics, Traditional Chinese Medical Hospital of Xiaoshan, Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 金波 |
JIN Bo |
浙江中医药大学附属江南医院 萧山中医院骨科八病区, 浙江 杭州 311201 |
Department of Orthopaedics, Traditional Chinese Medical Hospital of Xiaoshan, Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 许世超 |
XU Shi-chao |
浙江中医药大学附属江南医院 萧山中医院骨科八病区, 浙江 杭州 311201 |
Department of Orthopaedics, Traditional Chinese Medical Hospital of Xiaoshan, Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第2期，第105-110页 |
| DOI：10.3969/j.issn.1003-0034.2019.02.003 |
| 基金项目: |
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中文摘要:
目的：比较加长Gamma 3型髓内钉与股骨近端锁定钢板（proximal femur locking plate，PFLP）治疗股骨转子下骨折的临床疗效。
方法：回顾性分析2010年1月至2017年1月治疗股骨转子下骨折且随访超过12个月的58例患者，采用加长Gamma 3型髓内钉治疗35例，其中男18例，女17例；年龄25~78（66.5±23.5）岁；摔伤18例，交通伤7例，高处坠落伤10例；受伤至手术时间2~9 d，平均4.8 d。采用PFLP固定治疗23例，其中男8例，女15例；年龄31~81（63.4±22.4）岁；摔伤12例，交通伤6例，高处坠落伤5例；受伤至手术时间2~12 d，平均5.2 d。观察并比较两组患者的手术时间、总失血量（术中+隐性失血）、住院天数、骨折愈合情况、并发症及髋关节功能。
结果：51例获得随访，时间14~36个月，平均24.8个月。其中加长Gamma 3型髓内钉组31例，PFLP组20例。加长Gamma 3型髓内钉组总失血量（术中+隐性失血）高于PFLP组（P<0.05）；两组患者手术时间、住院天数、并发症比较差异无统计学意义（P>0.05）；术后骨折愈合时间加长Gamma 3型髓内钉组为（17.2±2.4）周与PFLP组（18.1±2.6）周比较差异无统计学意义（P>0.05）；加长Gamma 3型髓内钉组术后首次完全负重时间早于PFLP组（P<0.05）。术后1年随访加长Gamma 3型髓内钉组Harris评分80.29±10.28与PFLP组76.49±12.28比较差异无统计学意义（P>0.05）；两组患者均未发生深部感染、肺栓塞、骨不连等并发症；2例住院期间出现下肢深静脉血栓，予血管外科放置滤网治疗；术后4例出现肺部感染，经抗感染等治疗后治愈。
结论：加长Gamma 3型髓内钉及PFLP均能有效治疗股骨转子下骨折，加长Gamma 3型髓内钉不适于髓腔过细、前弓过大患者，PFLP因偏心固定，术后不应强调过早负重。 |
| 【关键词】股骨转子下骨折 骨折内固定,内 骨折固定术,髓内 |
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| Comparison of long Gamma 3 nail and proximal femur locking plate for the treatment of femoral subtrochanteric fractures |
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ABSTRACT
Objective: To compare clinical efficacy of long Gamma 3 nail and proximal femur locking plate (PFLP) in treating femoral subtrochanteric fractures.
Methods: From January 2010 to January 2017, clinical data of 58 patients with subtrochanteric fractures followed more than 12 months were retrospective analyzed. Among them, 35 patients were treated with long Gamma 3 nail including 18 males and 17 females aged from 25 to 78 years old with an average of (66.5±23.5) years old;Causes of injury included fall on the ground in 18 cases, traffic accidents in 7 cases, and fall from height in 10 cases. The other 23 patients were treated with PFLP fixation including 8 males and 15 females aged from 31 to 81 years old with an average of (63.4±22.4) years old;Causes of injury included fall on the ground in 12 cases, traffic accidents in 6 cases, and fall from height in 5 cases. Operative time, blood loss (intraoperative and hidden blood loss), hospital stays, bone healing and complications were observed and compared. Harris hip score after 1-year following-up was used to evaluate postoperative clinical effect.
Results: Fifty-one patients were followed up from 14 to 36 months with an average of 24.8 months, including 31 patients were treated with long Gamma 3 and 20 patients were treated with PFLP. Blood loss (intraoperative and hidden blood loss) in PFLP group was less than that of long Gamma 3 nail group (P<0.05). There was no significant in operative time, hospital stays and complications between two groups (P>0.05). There was no significant differences in healing time of fractures between long Gamma 3 nail group (17.2±2.4) weeks and PFLP group (18.1±2.6) weeks (P<0.05). At 1-year following-up, there was no significant differences in Harris hip score between long Gamma 3 nail group (80.29±10.28) and PFLP group (76.49±12.28) (P<0.05). No complications such as pulmonary embolism and nonunion occurred. Two patients were treated with fitler whose occurred deep vein thrombosis. Postoperative pulmonary infection curred in 4 cases and was cured by anti-infection therapy.
Conclusion: Both of long Gamma 3 nail and PFLP in treating patients with femoral subtrochanteric fractures can receive good clinical effects, long Gamma 3 nail is not suitable for the patients of the narrow medullary cavity and prominent anterior arch. PFLP is eccentric fixation, so early weight-bearing was not stress. |
| KEY WORDS Femoral subtrochanteric fractures Fracture fixation,internal Fracture fixation,intramedullary |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 韩雷,胡云根,汪灿锋,方伟利,金波,许世超.加长Gamma 3型髓内钉与股骨近端锁定钢板治疗股骨转子下骨折的疗效对比[J].中国骨伤,2019,32(2):105~110 |
| 英文格式: | HAN Lei,HU Yun-gen,WANG Can-feng,FANG Wei-li,JIN Bo,XU Shi-chao.Comparison of long Gamma 3 nail and proximal femur locking plate for the treatment of femoral subtrochanteric fractures[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(2):105~110 |
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