三种内固定方法治疗老年人骨质疏松性股骨粗隆间骨折的优缺点分析

摘要

Objective To compare the clinical curative effects of less invasive stabilization system (LISS), sliding dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) in treatment of osteoporotic intertro-chanteric fractures in the elderly. Methods By retrospective analysis of 67 cases of elderly patients with osteoporotic intertrochanteric fracture in our department (time limited from November 2011 to November 2013). There 23 LISS cases (Group LISS), 22 DHS cases (Group DHS), and 22 PFNA cases. Compared the general surgery conditions, post-operative Harris scores and the clinical efficacy at the 6th postoperative month of the three groups. Results The opera-tion time, intraoperative blood loss and osseous healing time of Group Liss were significantly more and longer than those of Group DHS and Group PFNA. The differences were statistically significant (P<0.05). The operation time, in-traoperative blood loss and osseous healing time of Group DHS were significantly more and longer than those of Group PFNA. The differences were statistically significant (P<0.05). The Harris scores respectively at the 1st and 6th postoperative month of Group LISS were significantly lower than those of Group DHS and Group PFNA. The differ-ences were statistically significant (P<0.05). There was no statistically significant difference between the distribution and excellent rate of clinical effect of three groups (P>0.05). Conclusion All three internal fixation methods showed similar efficacy in treatment of intertrochanteric femoral fracture. While PFNA showed its characteristics of less surgi-cal trauma and faster recovery time, compared to LISS and DHS, and can thus be the first choice in the elderly femoral intertrochanteric fracture operation.%目的：比较微创内固定系统(LISS)、滑动加压动力髋螺钉(DHS)和股骨近端防旋髓内钉(PFNA)三种内固定治疗老年人骨质疏松性股骨粗隆间骨折的临床疗效。方法回顾性分析我科2011年11月至2013年11月因骨质疏松性股骨粗隆间骨折的老年患者共67例，其中LISS组23例，DHS组22例，PFNA组22例，比较三组患者的手术一般情况、治疗后的Harris评分和治疗6个月后的临床疗效。结果 LISS组的手术时间、术中出血量、骨性愈合时间显著长于DHS组和PFNA组，差异均具有统计学意义(P<0.05)。DHS组的手术时间、术中出血量、骨性愈合时间显著长于PFNA组，差异均具有统计学意义(P<0.05)。LISS组术后1、6个月的Harris评分显著低于DHS组和PFNA组，DHS组术后1、6个月的Harris评分显著低于PFNA组，差异均具有统计学意义(P<0.05)。三组的临床疗效分布及优良率比较差异均无统计学意义(P>0.05)。结论三种内固定治疗老年股骨粗隆间骨折疗效相当，但PFNA相对LISS和DHS内固定，其手术创伤较小，康复时间快，可作为老年股骨粗隆间骨折手术首选。