髓内钉系统治疗股骨转子间骨折的疗效分析

Curative effect of femoral nail on intertrochanteric fracture

目的比较Gamma钉、PFN、PFNA等3种髓内钉固定系统治疗股骨转子间骨折的手术疗效。方法2005年6月至2007年6月第二军医大学附属长海医院共对112例股骨转子间骨折患者实施了髓内钉系统治疗,其中Gamma钉治疗39例、PFN治疗28例、PFNA治疗45例。通过对患者的手术时间、术中失血量、术后骨折愈合时间及髋关节功能情况进行回顾性分析综合判定其疗效,骨折愈合情况通过术后X线片判断,关节优良率根据Harris方法进行评定。结果112例患者中共有86例获完整资料随访,随访时间平均14.2个月（6～24个月）,PFNA组的手术时间、术中出血量与其它两组相比,差别有统计学意义（P〈0.05）。而PFN和Gamma钉组相比则无统计学差别。所有随访患者全部获得骨性愈合,各组愈合时间、关节优良率相比无统计学差别。结论治疗股骨转子间骨折的3种髓内钉系统中,PFNA相对操作简单,手术时间及术中失血量少,但3种临床疗效无明显差别。

Objective To analyze the curative effect of surgical treatment with Gamma nail,PFN,and PFNA on intertrochanteric hip fracture.Methods One hundred and twelve cases of fresh intertrochanteric hip fracture admitted from June.2005 to June.2007 were reviewed retrospectively.All cases were divided into three groups： group A was treated with Gamma nail,group B was treated with proximal femoral nail（PFN）,group C was treated with proximal femoral nail antirotation（PFNA）.Perioperaive indices of patients were statistically analyzed including operative time,blood loss,healing time of fracture,the function of hip joint.The healing condition of fracture was detected by X ray and the excellent and good rate of joint was evaluated by Harris method.Results Eighty-six cases were followed up for an average of 14.2 months（rage from 6 to 14 months）.Compared with other two groups,the operative time and blood loss in PFNA group decreased significantly（P〈0.05）.All the patients followed-up had bone healing.However,there were no significant difference in healing time of fracture and the excellent and good rate in 3 groups.Conclusion In above three intramedullary nail systems,PFNA is relatively convenient and it relatively reduces the operative time and blood loss,but the healing time of fracture and the excellent and good rate has no significant difference.