动力髋螺钉与股骨近端髓内钉治疗股骨粗隆间骨折疗效比较

Comparison between PFN and DHS in operative treatment of femoral intertrochanteric fractures

目的通过回顾性比较分析动力髋螺钉(DHS)与股骨近端髓内钉(PFN)治疗股骨粗隆间骨折的手术效果,探讨这两种内固定手术方法的临床疗效。方法通过从手术时间、切口长度,X线暴露次数、术中出血量、术后引流量、骨折临床愈合时间、术后并发症、术后功能恢复程度等方面比较两组间的结果,分析两种内固定方式的疗效,以及如何根据骨折类型选择适合内固定器材。结果DHS组和PFN组在切口长度、术中X线暴露次数、术中出血量、骨折临床愈合时间、术后功能恢复程度等方面比较差异有统计学意义(P<0.05)。与DHS组相比较,PFN组切口长度小,术中出血量少,骨折临床愈合时间短,术后功能恢复好,但X线暴露次数增加。结论对AO分类的A1和A2.1型稳定粗隆间骨折适用于DHS,对于A1、A2.2,A2.3,A3型应选用PFN治疗。

Objective To compare and to assess the effectiveness of treatment for intertrechanterie fractures by proximal femoral nail （PFN） and dynamic hip screw （DHS）. Methods Eighty - one patients with intertrechanterie hip fractures were treated by PFN （ PFN group） and DHS （ DHS group） during March 2003 to February 2007 and they were followed up after the operation. The data of patients in these two groups were collected for statistical analysis on following aspects： operation time, length of incision, fluoroscopy times, amount of blood loss, drainage, time of clinical healing of fracture, postoperative complications and Sanders Hip scores. Results The differences in length of incision, fluoroscopy times, amount of blood loss and time for clinical healing of fractures between DHS group and PFN group were of statistical significance （ P 〈 0.05 ）. In comparing with DHS group,PFN group was of shorter clinical healing, fewer blood loss and shorter length of incision, but with more fluoroscopic exposures. The difference in postoperative complications between these two groups was not statistically significant （ P 〉 0.05 ）. Conclusion By comparison, DHS is applicable for A1 and A2.1 and PEN is applicable for A1 ,A2.2, A2.3 and A3.