【摘要】 目的探讨髓内固定系统股骨近端防旋髓内钉(PFNA)、股骨近端髓内钉(PFN)及钉板系统动力髋螺钉(DHS)对老年骨质疏松性股骨粗隆间骨折的疗效及对患者血液相关指标的影响。方法回顾性分析2014年3月至2018年2月接受手术治疗的108例老年骨质疏松性股骨粗隆间骨折患者的临床资料,将采用3种不同内固定手术方式治疗的患者分为PFNA组、PFN组及DHS组,每组36例。比较3组患者的手术切口、手术时间、术中出血量等手术相关情况,术后并发症和3、6及12个月时髋关节恢复情况,以及术后不同时间点血液中C-反应蛋白(CRP)、肌红蛋白(Myo)及肌酸激酶(CK)水平。结果手术相关情况方面,PFNA组优于PFN组和DHS组,PFN组优于DHS组,差异均有统计学意义(P<0.05)。术后3个月和6个月,PFNA组Harris评分均显著高于PFN组和DHS组,PFN组显著高于DHS组(P<0.05);3组优良率差异无统计学意义(P>0.05)。术后12个月时Harris评分与术后3个月和6个月一致,但PFNA组优良率显著高于DHS组(P<0.05)。PFNA组患者术后总并发症发生率显著低于DHS组(P<0.05),PFNA组和PFN组、PFN组和DHS组相比差异均无统计学意义(P>0.05)。PFNA组和PFN组患者术后3 h、12 h、24 h的CRP、Myo及CK水平差异均无统计学意义(P>0.05),但均显著低于DHS组(P<0.05)。结论相比PFN和DHS,PFNA治疗老年骨质疏松性股骨粗隆间骨折效果最显著,患者骨折愈合最快,髋关节功能恢复最佳,术后并发症少且致残率较低,创伤小因而安全性高,是目前临床上值得推广的一种内固定手术治疗方法。更多还原

【Abstract】 Objective To investigate the effects intramedullary fixed system of proximal femoral nail antirotation(PFNA), proximal femoral nail(PFN) and tacking system of dynamic hip screw(DHS) on the curative effect of senile osteoporosis intertrochanteric fractures and the effects of blood parameters.Methods The clinical data of 108 elderly patients with osteoporosis intertrochanteric fracture who underwent surgical treatment in our hospital from March 2014 to February 2018 were retrospectively analyzed. The patients were divided into PFNA group, PFN group and DHS group. The operative incision, operative time, intraoperative amount of bleeding and other operative related conditions, postoperative complications and the recovery conditions of hip joint at 3 months, 6 months and 12 months, and the blood levels of c reactive protein(CRP), myoglobin(Myo) and creatine kinase(CK) at different time points after surgery were observe and compared among the three groups.Results In the aspects of surgical related conditions, PFNA group was superior to PFN group and DHS group, moreover the PFN group was superior to the DHS group(P<0.05). At 3 m and 6 m after operation, the Harris scores in PFNA group were significantly higher than those in PFN group and DHS group, moreover the Harris scores in PFN group were significantly higher than those in DHS group(P<0.05). However there was no significant difference in excellent rate(P>0.05). Moreovre the Harris scores at 12 m after surgery were consistent with those at 3 m and 6 m after surgery, but the excellent rate in PFNA group was significantly higher than that in DHS group(P<0.05). And the total incidence rate of postoperative complications in PFNA group was significantly lower than that in DHS group(P<0.05),but there was no significant difference in the total incidence rate of postoperative complications between PFNA group and PFN group, and between PFN group and DHS group(P>0.05). Moreover there were no significant differences in the levels of CRP, Myo and CK in PFNA group and PFN group at 3 h, 12 h and 24 h after operation(P>0.05), however the levels of CRP, Myo and CK in PFNA group and PFN group at 3 h, 12 h and 24 h after operation were significantly lower than those in DHS group(P<0.05).Conclusion As compared with PFN and DHS,the PFNA has the most significant effects in treatment of senile osteoporosis femoral intertrochanteric fracture. The patients who underwent PFNA have the fastest fracture healing, the best recovery of hip joint function, the least postoperative complications and the lowest disability rate. PFNA has small wound and high safety,therefor, which is worthy of clinical promotion at present.更多还原