PCCP与PFNA治疗高龄股骨粗隆间骨折临床疗效比较

摘要

Objective To compare the clinical effects between PCCP (percutaneous compression plating) and PF-NA (proximal femoral nail antirotation) in the treatment of intertrochanteric fracture in elderly patients. M ethods We retrospective analy 102 cases who were olderly patients with femoral intertrochanteric fracture They been treated in our hospital from September 2009 to June 2011. All the patients were followed up. We classified the patients into two groups according to the way of operation. There were 40 treated with PCCP fixation and 52 with PFNA. The data of each group were collected for statistical analysis on the following aspects : the operative time, bleeding , wound drainage,walking time,fracture healing time,postoperative complications and hip function.Results All patients were followed up for 8. 3 months (range 7 to 16 months). The mean bleeding ,wound drainage in PCCP group were significantly lower than the PFNA group (P< 0. 05). However,walking time in PFNA group were significantly longer than the PCCP (P< 0. 05). Harris hip score of the two groups were significantly improved after operation. PENA seems better ,but there was no statistic different between PCCP and PFNA (P> 0. 05). The operative time,fracture healing time and postoperative complications was similar in two groups (P> 0. 05). Conclusion Both the PCCP and PFNA are fixation for stable femoral intertrochanteric fracture in the elderly patients and they all have good clinic effect. PCCP is more suitable for stability femoral intertrochanteric fracture type including type 31A1 and type 31A2. For unstable,type 31A2fracture and serious osteoporosis fracture,we had better to choose PFNA intramedullary fixation to get a better mechanical stability.%目的 探讨经皮加压钢板(percutaneous compression plating,PCCP)与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨粗隆间骨折的临床疗效.方法 回顾性分析2009年9月至2011年6月我院收治资料完整、均获得随访的92 例股骨粗隆间骨折患者,根据手术方式不同,将患者分为PCCP组40 例,PFNA组52 例.比较两种术式对手术时间、术中出血量、术后伤口引流量、术后下地负重时间、骨折愈合时间、并发症及Harris髋关节功能评分等指标.结果 所有患者均获得随访,随访7～16个月,平均8.3个月.PCCP组在术中出血量、术后伤口引流量上优于PFNA组(P＜0.05);而PFNA组术后下地时间优于PCCP组(P＜0.05),内固定后两组Harris髋关节功能评分较治疗前明显改善,PFNA组优良率更高,但差异无统计学意义(P＞0.05),在手术时间、骨折愈合时间、术后并发症上无明显区别.结论 PCCP和PFNA均是治疗高龄股骨粗隆间骨折的内固定材料,在稳定型骨折类型中均可获得满意的临床疗效.PCCP更适合于高龄股骨粗隆31A1,31A2的稳定性骨折;对于不稳定的31A2型骨折和严重骨质疏松的骨折,应选用PFNA髓内固定,以获得更佳的力学稳定性.