【摘要】 目的:比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定和动力髋螺钉(dynamic hip screw,DHS)内固定治疗老年股骨转子间骨折的临床疗效和安全性。方法:回顾性分析280例股骨转子间骨折患者的病例资料,其中采用PFNA内固定180例,采用DHS内固定100例。男169例,女111例;年龄61~77岁,中位数65岁;按照股骨转子间骨折的Evans分型,Ⅰ型62例、Ⅱ型73例、Ⅲ型73例、Ⅳ型72例。比较2组患者的切口长度、出血量、手术时间、引流量、卧床时间、骨折愈合时间及并发症发生情况,并于术后6个月比较2组患者的临床疗效。结果:1一般指标。PFNA组的切口长度、出血量、引流量均小于DHS组[(4.44±1.49)cm,(6.34±2.44)cm,t=3.737,P=0.034;(205.25±24.54)m L,(298.29±28.64)m L,t=4.055,P=0.028;(64.46±10.67)m L,(105.11±19.84)m L,t=4.874,P=0.020],其手术时间、卧床时间、骨折愈合时间均短于DHS组[(68.68±14.43)min,(96.44±11.25)min,t=4.462,P=0.022;(34.51±7.88)d,(53.38±8.59)d,t=5.448,P=0.016;(3.22±1.13)月,(4.07±1.85)月,t=4.366,P=0.025]。2临床疗效。PFNA组优110例、良59例、可10例、差1例,DHS组优55例、良30例、可10例、差5例;2组患者的临床疗效比较,差异无统计学意义(Z=-1.495,P=0.135)。3安全性。PFNA组1例患者术后切口感染,3例患者骨折畸形愈合,4例患者下肢深静脉血栓形成;DHS组3例患者术后切口感染,2例患者内固定断裂,4例患者骨折畸形愈合,3例患者下肢深静脉血栓形成。PFNA组并发症发生率低于DHS组(χ2=5.533,P=0.019)。结论:对于老年股骨转子间骨折患者而言,虽然PFNA内固定与DHS内固定在临床疗效方面无明显差异,但PFNA内固定具有手术切口小、出血量和引流量少、手术时间短、骨折愈合快、患者卧床时间短、并发症少的优点,是治疗股骨转子间骨折的一种较理想的方法,值得临床推广应用。更多还原

【Abstract】 Objective: To compare the clinical curative effects and safety of proximal femoral nail antirotation( PFNA) internal fixation versus dynamic hip screw( DHS) internal fixation in the treatment of intertrochanteric fractures in the aged. Methods: The medical records of280 patients with intertrochanteric fractures were analyzed retrospectively. One hundred and eighty patients were treated with PFNA internal fixation( PFNA group),while the others were treated with DHS internal fixation( DHS group). The patients consisted of 169 males and 111 females,and ranged in age from 61 to 77 years( Median = 65 yrs). According to the Evans classification of intertrochanteric fractures,the fractures belonged to typesⅠ( 62),Ⅱ( 73),Ⅲ( 73) and Ⅳ( 72). The incision length,blood loss,operative time,volume of drainage,bed rest time,fracture healing time and complications were compared between the 2 groups,and the clinical effects were also compared between the 2 groups at 6 months after surgery. Results: The incision length,blood loss and volume of drainage of PFNA group were less than those of DHS group( 4. 44 + /- 1. 49 vs 6. 34 + /- 2. 44 cm,t = 3. 737,P = 0. 034; 205. 25 + /- 24. 54 vs 298. 29 + /- 28. 64 m L,t = 4. 055,P =0. 028; 64. 46 + /- 10. 67 vs 105. 11 + /- 19. 84 m L,t = 4. 874,P = 0. 020),and the operative time,bed rest time and fracture healing time were also shorter in PFNA group compared to DHS group( 68. 68 + /- 14. 43 vs 96. 44 + /- 11. 25 min,t = 4. 462,P = 0. 022; 34. 51 + /-7. 88 vs 53. 38 + /- 8. 59 days,t = 5. 448,P = 0. 016; 3. 22 + /- 1. 13 vs 4. 07 + /- 1. 85 months,t = 4. 366,P = 0. 025). One hundred and ten patients obtained an excellent result,59 good,10 fair and 1 poor in the PFNA group; while 55 patients obtained an excellent result,30 good,10 fair and 5 poor in the DHS group. There was no statistical difference in clinical effects between the 2 groups( Z =- 1. 495,P =0. 135). Incision infection( 1 case),fracture malunion( 3 cases) and lower extremity deep venous thrombosis( 4 cases) were found in PFNA group; while incision infection( 3 case),breakage of internal fixation( 2 cases),fracture malunion( 4 cases) and lower extremity deep venous thrombosis( 3 cases) were found in DHS group. The incidence rate of complications of PFNA group was lower than that of DHS group( χ2=5. 533,P = 0. 019). Conclusion: There are no significant difference in clinical curative effects between PFNA internal fixation and DHS internal fixation,however,PFNA internal fixation is an ideal method for treatment of intertrochanteric fractures in the aged for small incision,less blood loss and volume of drainage,shorter operative time,shorter fracture healing time,shorter bed rest time and less complications,so it is worthy of popularizing in clinic.更多还原