老年不稳定股骨转子间骨折手术内固定材料的选择

摘要

目的 探讨老年不稳定股骨转子间骨折手术内固定材料的选择策略.方法 对84例老年股骨转子间骨折患者分别采用动力髋螺钉(DHS组)、股骨近端解剖锁定钢板(PFLP组)和股骨近端防旋髓内钉(PFNA组)手术治疗,比较3组切口长度、手术时间、术中出血量、术后负重时间、骨折愈合时间、并发症情况及Harris髋关节功能评分,评价3种内固定方法的术后疗效.结果 患者均随访12个月.切口长度、手术时间、术中出血量、术后负重时间、骨折愈合时间PFNA组均优于DHS组和PFLP组(P<0.001),骨折愈合时间PFLP组优于DHS组(P<0.01).术后12个月髋关节功能Harris评分优良率:PFNA组均优于DHS组和 PFLP组(P<0.05),PFLP组优于DHS组(P<0.05).结论 对于内科病情复杂、身体条件较差、不能耐受长时间手术的老年不稳定性股骨转子间骨折患者,建议优先采用PFNA系统.%Objective To investigate the selection strategy of internal fixation devices for unstable intertrochanteric fractures in the elderly.Methods The 84 cases of elderly intertrochanteric fractures were treated with dynamic hip screw (DHS),proximal femoral anatomically locking plate (PFLP) and proximal femoral intramedullary nail (PF-NA). The incision length, the total operation time, intraoperative bleeding volume, postoperative time to weight bearing,fracture healing time,postoperative complications and Harris hip scores were compared. The postoperative efficacy of the three internal fixation methods was evaluated. Results The patients were all followed up for 12 months.In PFNA group,the incision length,total operation time,intraoperative bleeding volume,postoperative time to weight bearing,fracture healing time and postoperative complications at 12 months postoperation were better than those of the DHS group and the PFLP group(P<0.001),and fracture healing time changes in the PFLP group was superior to DHS group(P<0.01). The Harris hip scores of 12 months postoperation,the PFNA group was superior to the DHS group and the PFLP group(P<0.05),and the PFLP group was superior to the DHS group(P<0.05). Conclusions PFNA system is recommended for the elderly patients with complex intertrochanteric fractures of the fe-mur with complicated physical condition and poor physical condition,and can not tolerate prolonged operation.