微创 PFNA 内固定治疗股骨粗隆间骨折临床疗效分析

摘要

目的：观察微创股骨近端防旋髓内钉（ proximal femoral nail anti－rotation，PFNA）内固定治疗股骨粗隆间骨折的临床疗效，并分析其不良反应及评估其安全性。方法选择该院2012－01～2013－01收治的股骨粗隆间骨折患者60例作为研究对象，按照随机数字表法分为两组，每组30例，观察组采用微创PFNA内固定治疗，对照组采用动力髋螺钉系统（ dynamic hip screw ，DHS）治疗，随访1年，比较两组患者疗效，评估Harris髋关节评分以评估患者髋关节功能恢复情况，并统计两组并发症发生率。结果观察组手术时间、出血量、负重时间、骨折愈合时间分别为（69．7±17．4）min、（317．9±81．3）ml、（96．4±11．3）d、（18．5±3．1）w，均明显优于对照组的（89．4±19．1）min、（476．3±89．5）ml、（113．3±12．5）d、（21．9±3．2）w，差异有统计学意义（P＜0．01）；观察组Harris髋关节评分优19例（63．3％），良7例（23．3％），一般3例（10．0％），差1例（3．3％），明显优于对照组（P＜0．01）；观察组术后出现髋内翻1例（3．3％），延迟愈合1例（3．3％），并发症发生率为6．7％，对照组髋内翻1例（3．3％），延迟愈合1例（3．3％），骨折不愈合1例（3．3％），并发症发生率为10．0％，两组并发症发生率比较差异无统计学意义（ P＞0．05）。结论微创股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折临床疗效较佳，且术后并发症少，较为安全。%Objective To observe the clinical efficacy of minimally invasive proximal femoral nail anti rotation ( proximal femoral nail anti-rotation PFNA) in the treatment of intertrochanteric fractures of femur , and to evaluate its safety and adverse reaction .Methods 60 patients with intertrochanteric fractures of femur were collected in our hospi-tal from January 2012 to January 2013 and were divided randomly into two groups , with 30 cases in each group .The ob-servation group received minimally invasive internal fixation of PFNA and the control group received dynamic hip screw (dynamic hip screw,DHS) treatment with a follow-up of 1 years.The efficacy rate, Harris hip score and the incidence of complication were compared between the two groups .Results The operation time, bleeding volume, load time, frac-ture healing time in the observation group were (69.7 ±17.4)min, (317.9 ±81.3)ml, (96.4 ±11.3)d and (18.5 ± 3.1)w respectively, and were significantly better than those in the control group[(89.4 ±19.1)min, (476.3 ±89.5)ml, (113.3 ±12.5)d and (21.9 ±3.2)w](P<0.01);Harris hip scores of the observation group were excellent in 19 ca-ses(63.3%), good in 7 cases(23.3%),modest in 3 cases(10.0%), poor in 1 case(3.3%), which was significantly better than those of the control group , P<0.01.The patients in the observation group occurred coxa vara in 1 case (3.3%), delayed union in 1 case(3.3%), with the incidence of adverse reactions in 6.7%and there was no signifi-cant difference between the two groups , P>0.05.Conclusion The effect of minimally invasive PFNA in the treatment of femoral intertrochanteric fracture Kerr is efficacious and safe and has less postoperative complications .