两种内固定治疗老年股骨转子间骨折的疗效比较

A comparative study of two treatments methods for elderly femoral intertrochanteric fractures

目的观察股骨近端解剖锁定钢板（PFLCP）和动力髋螺钉（DHS）两种内固定治疗老年股骨转子间骨折的临床疗效。方法对108例老年股骨转子间骨折分别采取PFLCP（64例）和DHS（44例）内固定治疗。对比两组患者的切口长度、手术时间、术中出血量、住院时间、骨折愈合时间、功能评价情况。结果 108例患者均获随访,时间9~18个月。两组患者切口长度、手术时间、出血量及住院时间比较差异均无统计学意义（P〉0.05）。骨折愈合时间：PFLCP组（10.2±2.7）周,DHS组（12.8±3.5）周,差异有统计学意义（P〈0.05）。末次随访时髋关节Harris评分评价疗效：PFLCP组优良率92.18%,DHS组优良率77.27%,差异有统计学意义（P〈0.05）。术后螺钉松动、骨折移位、关节活动受限、感染等并发症发生率：PFLCP组6.25%,DHS组18.18%,差异有统计学意义（P〈0.05）。结论 PFLCP内固定治疗老年股骨转子间骨折操作简单,骨膜剥离少,固定可靠,效果显著,并发症少。

Objective To observe the clinical effect of proximal femoral locking compression plate（ PFLCP） and dynamic hip screw（ DHS） for treatment of elderly femoral intertrochanteric fractures. Methods A retrospective study of 108 patients with elderly femoral intertrochanteric fracture who had been treated by PFLCP（ 64 cases） or DHS（ 44cases） was carried out. It was compared for two groups in length of wounds,operation time,volume of intraoperative bleeding,hospitalization,fracture healing time,fuction evaluation. Results 108 cases were followed up from 9months to 18 months. There were no significant differences between two groups in length of wounds,operation time,volume of intraoperative bleeding,hospitalization（ P〈0. 05）. There were significant difference between two groups in fracture healing time（ P〈0. 05）,which was（ 10. 2 ± 2. 7） weeks in PFLCP group and（ 12. 8 ± 3. 5） weeks in DHS group. Excellent and good rate in PFLCP group（ 92. 18%） were better than that in DHS group（ 77. 27%）,the difference was significant（ P〈0. 05）. There was significant difference between two groups regarding to the loose screws,fracture displacement,joint mobility,infections and other complications that in PFLCP group（ 6. 25%）,DHS group（ 18. 18%）（ P〈0. 05）. Conclusions PFLCP is an effective method in the treatment of elderly femoral intertrochanteric fractures. PFLCP is simple,less periosteal stripping,reliable fixation,with better effect and fewer complications.