股骨近端防旋髓内钉与加压滑动钢板治疗老年股骨粗隆间骨折的疗效观察

摘要

Objective To compare the effect of proximal femoral nail anti-rotation ( PFNA) and dynamic hip screw(DHS)in the treatment of intertrochanteric fractures and to investigate their clinical effects .Methods Totally 52 elderly patients (19 males and 33 females aged from 62-88 with an average of 73.6 years) with femoral intertrochanteric fracture from Mar .2010 to Nov.2014 were selected.They were treated with internal fixation with PFNA(n=27) and DHS(n=25).The operation time,bleeding volume,healing time of the wounds,healing time of the fracture and postoperative rehabilitation time of the two groups were compared .Results Patients were followed up for 10-26 months.According to Harris score ,the total effective rate of the PFNA group was 91.6%,and the total effective rate of the DHS group was 84.5%.Infection occurred in one case ,deep venous thrombosis occurred in one case,and deformity in one case in the PFNA group .In the DHS group,nails displaced in two cases , bone union oc-curred in one case and one case developed nail breakage and malunion .There were statistical differences in surgical wound,average operation time ,bleeding volume ,healing time of the wounds and healing time of the fracture between the two groups(P<0.05).Conclusion PFNA internal fixation for intertrochanteric fracture of femur in the elder-ly patients can shorten operation time , lessen bleeding , and improve the prognosis of patients in comparison with DHS.It is safe and effective and is an ideal operation method for treating intertrochanteric fractures in elderly pa -tients.%目的：通过股骨近端防旋髓内钉（ PFNA）系统与加压滑动钢板（ DHS）系统治疗老年股骨粗隆间骨折，对比两种内固定方法的疗效并进行分析。方法笔者回顾性分析2010年3月～2014年11月治疗的52例老年股骨粗隆间骨折临床资料，男性19例，女性33例；年龄62～88岁，平均73.6岁。受伤原因：摔伤43例，道路交通伤5例，坠落伤4例。27例行PFNA治疗，25例行DHS内固定治疗。比较两组手术时间、伤口长度、出血量、伤口愈合时间、骨折愈合时间、功能锻炼时间等指标。结果随访10～26个月。按照Harris评分，PFNA内固定组优良率91.6％，DHS内固定优良率84.5％。 PFNA组1例伤口感染，1例术后深静脉栓塞，1例髋内翻畸形愈合；DHS组出现2例主钉退至皮下，1例骨不连再次手术，1例螺丝钉断裂畸形愈合。 PFNA组在手术时间、出血量、伤口愈合时间、骨折愈合时间、功能锻炼时间等方面均优于DHS组，差异有显著统计学意义（P＜0.05）。结论 PFNA内固定系统在手术创伤、手术时间、出血量、骨折愈合、功能恢复等方面明显优于DHS内固定。 PFNA安全有效，是治疗老年股骨粗隆间骨折的理想方法。