不同治疗方法对老年骨质疏松性股骨粗隆间骨折的疗效观察

摘要

Objective To compare the efficacy of 3 different internal fixation treatments, dynamic hip screw ( DHS ) , prestressed concrete cylinder pipe ( PCCP ), and proximal femoral nail anti-rotation ( PFNA ), on senile osteoporotic femoral intertrochanteric fractures, and to provide reference for the choice of clinical operation. Methods A total of 168 senile patients with osteoporotic femoral intertrochanteric fractures who received operation therapy in our hospital were selected. All the subjects were randomly divided into 3 groups: DHS group ( 59 cases ), PCCP group ( 46 cases ), and PFNA group ( 55 cases ). Results including the situation of operation, healing efficacy, bone union time, and postoperative complications were compared among 3 groups. Results Intraoperative blood loss in PFNA group was 172 ± 19. 6 ml. The amount of blood loss in PCCP group and DHS group was 167 ± 16. 8 ml and 367 ± 32. 3 ml, respectively, and the difference was significant ( P <0. 01 ). The total rate of postoperative complications in PFNA group, PCCP group, and DHS group was 5.3% , 11.3% , and 17.2% , respectively. The difference was significant between each 2 groups by Chi-square test ( P < 0. 05 ). The bone union time in DHS group, PCCP group, and PFNA group was 14.7 ±2.4 weeks, 13.6 ±1.7 weeks, and 13.0 ±1.4 weeks, respectively. The difference between PFNA group and DHS group was significant ( P <0. 05 ). Excellent and good rate in DHS group, PCCP group, and PFNA group was 81.0% , 83.0% , and 89.5% , respectively. There was no significant difference between each 2 groups ( P > 0. 05 ). Conclusion Internal fixation with PFNA has short bone union time after operation, low rate of complications, and good clinical efficacy. PFNA is suitable for internal fixation of senile osteoporotic femoral intertrochanteric fractures.%目的 通过比较DHS、PCCP和PFNA三种不同内固定治疗方法对老年骨质疏松性股骨粗隆间骨折疗效,为临床手术方法的选择提供参考依据.方法 选取在我院接受手术治疗的168例老年骨质疏松性股骨粗隆间骨折患者,随机分为三组:DHS组58例、PCCP组53例和PFNA组57例,比较分析3组患者的手术情况、疗效和骨折愈合时间及术后并发症.结果 PFNA组患者术中出血量为(172±19.6)ml,PCCP(167±16.8)ml与DHS(367±32.3)ml相比,差异有统计学差异(P<0.01).术后并发症总发生率PFNA组为5.3%,PCCP组为11.3%,DHS组为17.2%,经卡方检验,任意两组间差异均有统计学意义(P<0.05).DHS组、PCCP组和PFNA 组骨折愈合时间分别为(14.7±2.4)周,(13.6±1.7)周,(13.0±1.4)周,PFNA 组与DHS组相比,差异有统计学意义(P<0.05).DHS组、PCCP组和PFNA 组优良率分别为81.0%、83.0% 和89.5%,组间疗效差异无统计学意义(P>0.05) 结论 PFNA内固定法术后骨折愈合时间短,并发症发生率低,临床疗效较好;PFNA内固定法较适合治疗老年骨质疏松性股骨粗隆间骨折的治疗.