股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的疗效观察

Therapeutic efficacy of proximal femoral nail anti-rotation internal fixation on intertrochanteric fracture

目的探讨股骨近端防旋髓内钉(PFNA)内固定术与动力髋螺钉(DHS)内固定术2种不同内固定方式治疗股骨粗隆间骨折的临床疗效。方法选取我院骨科2014年6月至2016年6月收治的老年股骨粗隆间骨折患者106例,按不同的内固定方式分为PFNA组和DHS组,每组53例。比较2组患者的手术相关项(创口大小、手术时间、术中出血量、术后卧床时间、负重时间和骨折愈合时间)、术后并发症发生情况和髋关节功能评分(Harri评分)。结果 PFNA组患者手术时间、术后卧床时间、负重时间和骨折愈合时间均明显短于DHS组(P<0.05或<0.01),且创口小于DHS组(P<0.01),术中出血量少于DHS组(P<0.01)。PFNA组患者术后并发症发生率为7.55%(4/53),DHS组患者术后并发症发生率为22.6%(12/53),差异有统计学意义(P<0.05)。PFNA组术后Harri评分优良率明显高于DHS组(P<0.05)。结论股骨近端PFNA内固定微创治疗老年股骨粗隆间骨折明显优于DHS内固定术,疗效好,并发症少,是治疗老年股骨粗隆间骨折的理想术式。

Objective To investigate the clinical efficacy of proximal femoral nail anti-rotation （ PFNA） internal fixation and the dynamic hip screw （DHS） internal fixation on intertrochanteric fracture. Methods One hundred and six senile patients with femo-ral intertrochanteric fracture admitted into the Orthopedic Department of the hospital from June 2014 to June 2016 were recruited as re-search subjects. The patients were divided into the PFNA group and the DHS group, in accordance with different fixation methods, each consisting of 53 patients. Comparisons were made on such surgery-related data as size of wound opening, surgical time, blood loss, postsurgical laid-up time, load time and fracture healing time, as well as incidence of complications and Harri scores of hip joint func-tion between the patients of the 2 groups. Results Surgical time, postsurgical laid-up time, load time and fracture healing time of the PFNA group were all significantly shorter than those of the DHS group （P 〈0. 05 or P 〈 0 .0 1 ） . Furthermore, the size of wound opening of the PFNA group was smaller than that of the DHS group（P 〈0. 01 ） , and blood loss during surgery in the PFNA group was less than that of the DHS group（P 〈0. 01） . The rate of complications for the patients of the PFNA group （7. 55% ） （4/53） was obviously lower than that of the DHS group （22. 6% ） （12/53） , and statistical significance could be seen, when comparisons were made between the 2 groups（P 〈0. 05 ）. The rate of complications of the PFNA group after surgery was lower than that of the DHS group （P 〈0. 05） , and Harri scores of the PFNA group after surgery were significantly higher than those of the DHS group, with statistical significance （P 〈 0. 05）. Conclusion Proximal femoral nail anti-rotation （PFNA） internal fixation in the treatment of femoral intertrochanteric fracture in senile patients was obviously superior to dynamic hip screw internal fixation, with the advantages of better efficacy and fewer compli-cations. For this reason, it was an ideal method for the treatment of femoral intertrochanteric fracture in senile patients.