PFNA及PFNAⅡ治疗股骨转子间骨折疗效分析

摘要

目的 比较股骨近端螺旋刀片抗旋髓内钉(PFNA)与其改进型PFNAⅡ治疗股骨转子间骨折的疗效.方法 自2008年7月至2010年7月,对50例股骨转子间骨折患者行闭合复位内固定术,其中25例接受PFNA,另25例接受PFNAⅡ.术后平均随访12.8个月,并对照评估两组患者平均手术时间、术中出血量,术后负重时间、骨折临床愈合时间、术后大腿疼痛率、Harris髋关节评分等.结果 两组患者术后未发现切口感染、退钉、股骨头切割或坏死、股骨干骨折、下肢深静脉血栓形成及明显髋内外翻畸形等并发症.PFNAⅡ组较PFNA组平均手术时间短(P＜0.05)、术中出血最少(P＜0.05);两组术后负重时间无明显差异;PFNAⅡ组术后大腿疼痛发生率较PFNA组低(P＜0.05);两组术后髋关节功能恢复良好,Harris评分无明显差异.结论 采用闭合复位 PFNA及PFNAⅡ内固定治疗股骨转子间骨折的疗效满意,PFNAⅡ专为亚洲人种设计,更符合我国人群股骨近端解剖结构,手术更加方便、快捷,术后大腿疼痛发生率低.%Objective To compare the clinical effect of treating intertrochanteric fractures with proximal fernoral nail antirotation (PFNA) and PFNAⅡ. Methods From July 2008 to July 2010, 50 patients of intertrochanteric fracture were treated with closed reduction and internal fixation. According to the kind of the internal fixation material during operation, 50 patients were divided into PFNA group(25 cases)and PFNAⅡ group(25 cases), the average followed-up period was 12. 8 months, and the average operation time, intraoperative blood loss, weight loading time, clinical healing time, postoperative thigh pain and Harris Hip Score(HHS) in two groups cases were evaluated and compared. Results No case presented infection of incisional wound,withdraw of nail, femoral head cut-out, femural shaft fracture, deep venous thrombosis and obviously coxa varus or valgus deformity in two groups. The average operation time in PFNAⅡ group was shorter than in PFNA group(P＜0. 05) and the blood loss was lesser in PFNAⅡ group(P＜0.05), there was no significant difference in the postoperative weight loading time in two groups,the incidence of postoperative thigh pain in PFNAⅡ group was lower in PFNA group(P＜0. 05), end all cases' hip joint function was recovered well, the postoperative HHS was no significant difference in two groups. Conclusions The clinical effect of treating intertrochanteric fractures with PFNA and PFNAⅡ is satisfied. Because of special design for Asian, PFNAⅡ is more in line with the Chinese people's proximal femur anatomic structure, the operation become more convenience and quick, the inddence of postoperative thigh pain is lower.