抗旋转型股骨近端髓内钉内固定与动力髋螺钉内固定治疗股骨转子间骨折的临床疗效对比观察

摘要

Objective To explore and study the clinical effects of the internal fixations of proximal femoral nail antirotation(PFNA) and dynamic hip screw(DHS) for femoral intertrochanteric fracture.Methods 100 patients with femoral intertrochanteric fracture admitted into our hospital from April,2009 to April,2013 were selected as study objects and randomly and equally divided into two groups.50 patients (PFNA group) were treated by the internal fixation of PFNA,and the other 50 patients (DHS group) by the internal fixation of DHS.They were followed up for 9-18 months.The curative effects of both groups were observed and compared.Results The volumes of intraoperative bleeding and of the postoperative drainage were smaller and the postoperative weight-loading walking time and healing time were shorter in the PFNA group than in the DHS group.The Harris hip function scores were increased in both groups after the treatment; the hip function scores,motion ranges,and synthetic scores were increased more but the hip joint score of deformity less in the PFNA group than in the DHS group.The incidence of postoperative complications of the PFNA group was 6.0％,which was significantly lower than that of the DHS group (26.0％),with a statistical difference (P＜0.05).Conclusions PFNA has better curative effects than DHS in the treatment of femoral intertrochanteric fracture and has greater comparative advantages in intraoperative bleeding volume,postoperative healing time,and weight-bearing walking time.Comparing with DHS treatment,PENA treatment causes fewer postoperative complications and recovers hip joint function better,so it can be the first treatment choice for patients with femoral intertrochanteric fracture.%目的 探究抗旋转型股骨近端髓内钉(PFNA)内固定与动力髋螺钉(DHS)内固定在股骨转子间骨折中的临床疗效.方法 选取自2009年4月至2013年4月我院收治的股骨转子间骨折患者100例,将其作为研究对象,随机分为两组,每组各50例.PFNA组患者采取抗旋转型股骨近端髓内钉进行内固定;DHS组患者采取动力髋螺钉内固定治疗.术后跟踪随访9～ 18个月,观察比较两组患者的疗效.结果 PFNA组术中出血量、术后引流量明显少于DHS组,术后开始下地负重行走时间、骨折愈合时间均较DHS组早;两组患者Harris髋关节功能评分较治疗前增加,且PFNA组患者的髋关节功能、运动范围及综合评分手术前后的增加值均高于DHS组,而髋关节畸形评分增加值则较DHS组低.PFNA组患者术后并发症的发生率为6.0％(3例),明显低于DHS组的26.0％(13例),P＜ 0.05,具有统计学意义.结论 PFNA在股骨转子间骨折患者中的疗效优于DHS,PFNA在术中出血量、骨折愈合时间、术后地负重行走时间等方面具有更大的优势,而且与DHS比较,术后并发症少、髋关节功能恢复好,可作为股骨转子间骨折患者手术的首选内固定方法.