摘要目的 比较研究用于微创治疗股骨转子间骨折的同直径双主钉的髓内和髓外设计的两种内固定系统的临床治疗效果.方法 选择2005至2008年同期进行的两组股骨转子间骨折病例,均为AO/OTA分型A1和A2型骨折,其中髓外固定使用经皮加压钢板(percutaneous compression plating,PCCP)36例,髓内固定使用Trigen短重建钉48例,分别进行平均(16.3±3.2)个月随访.随访中临床评估包括术后1周,1、3、6个月和1年的疼痛视觉模拟评分(visual ahalogue scale,VAS)和1年后Harris髋功能评分;放射学评估包括骨折愈合时间、内固定主钉位置及骨折端加压短缩尺度,并记录并发症发生情况.结果 两组病例在手术时间和临床失血量方面差异并无统计学意义.PCCP组早期疼痛的缓解效果优于Trigen短重建钉组,主要表现在术后前3个月内,此后两组疼痛评分差异无统计学意义.PCCP组的骨折愈合时间和Harris评分均优于Trigen短重建钉组,差异有统计学意义.同时,PCCP组显示出更大尺度主钉回退和骨折端加压短缩情况.Trigen短重建钉组术后出现1例大转子劈裂、3例股骨干部骨折,其中1例进行翻修;而PCCP组无内固定周围骨折发生,但存在1例早期主钉切割移位.结论 PCCP和Trigen短重建钉均可满意地用于A1和A2型转子间骨折的微创治疗,其中髓外应用的PCCP具有疼痛缓解早、固定位置好、愈合时间短和并发症少等优点.

abstractsObjective To compare the clinical results of percutaneous compression plating (PCCP)and Trigen short reconstruction intramedullary nail for intertrochanteric hip fractures. Methods During 2005 and 2008, the patients suffered with AO/OTA Al and A2 intertrochanteric hip fractures were divided into two groups; 36 fractures were treated with PCCP and 48 fractures with Trigen short reconstruction nail.During an average of (16.3±3.2) months follow-up, clinical evaluation involved visual analogue scale(VAS)score for pain in the 1st week, the 1st month, the 3rd month, the 6th month and the 12th month, and a Harris hip score one year post operation. Radiographs were examined for fracture healing-time, displacement scale of the neck screws and fracture impaction scale. All the complication in both groups was recorded. Results There were no difference in blood loss and operation time in both groups. The postoperative pain was significantly lower in the PCCP group in the initial three months after the surgery. Larger scale of fracture impaction and screw telescoping were seen in PCCP group. Also shorter healing time, higher Harris score results were achieved in PCCP group than those of Trigen short reconstruction nail group. Four peri-implant fractures occurred in Trigen short reconstruction nail group, which included one in the greater trochanter and three in the femoral shaft, but only one case need revision for bone displacement. In PCCP group, it was found that the superior neck screw was slightly displaced for tendency to cut-out in one patient. Conclusion Both PCCP and Trigen short reconstruction intramedullary nail can be successfully used to treat Al and A2 intertrochanteric hip fractures with minimal invasive technique. And the PCCP showed more rapid pain relief and bone healing, easily bony reduction and fewer complications.