股骨近端髓内钉与防旋股骨近端髓内钉治疗股骨转子间骨折的比较

Treatment of intertrochanteric fractures by proximal femoral nail and proximal femoral nail antirotation： a comparative study

目的比较股骨近端髓内钉（proximal femoral nail，PFN）与防旋股骨近端髓内钉（proximal femoral nail antirotation，PFNA）两种内固定方法治疗股骨转子间骨折的效果。方法回顾性分析PFN和PFNA治疗股骨转子间骨折患者233例，其中PFN组188例，PFNA组45例。对两组患者的手术资料和术后功能恢复情况进行比较。结果平均随访22．8个月。两组骨折均获得愈合。两组切口长度、手术时间、术中出血量差异具有统计学意义。PFN组优良率为89．9％，PFNA组优良率为91．1％，差异无统计学意义（χ^2=0．06，P〉0．05）。PFN组防旋钉退出2例，1例发生髋螺钉切割，继而发生髋内翻畸形。PFNA组未发生类似并发症。结论两种股骨近端髓内钉对股骨转子间骨折均能起到良好的治疗作用。PFNA较PFN手术时间更短，出血量更少，对老年骨质疏松患者更具优势。

Objective To compare the treatment effectiveness of AO/ASIF proximal femoral nail （PFN） and proximal femoral nail antirotation （PFNA） in treatment of intertrochanterie fractures. Methods A retrospective study was done on 233 patients with intertroehanterie fractures treated from August 2004 to December 2006. The patients were divided into PFN group （188 patients） and PFNA group （45 patients） for comparing operative procedures and postoperative functional recovery. Results There was statistical difference in aspects of incision length, blood loss and operation time between two groups. The follow-up for 22.8 months showed excellence rate of 89.9% in PFN group and 91.1% in PFNA group, with statistical difference （ χ^2 = 0.06, P 〉 0.05 ）. There occurred hip varus in one patient and antirotation nail cutting-out in two in PFN group, which was not found in PFNA group. Conclusion PFN and PFNA are both good choices for treatment of intertrochanteric fractures. Compared with PFN, PFNA has more advantages in reducing operation time and blood loss especially for the elder patients with osteoporosis.