股骨近端髓内钉与动力髋螺钉治疗股骨粗隆间骨折的比较

Comparison of proximal femoral nail and dynamice hip screw for treating intertrochanteric fractures

目的:探讨股骨近端髋内钉(proximal femoralnail,PFN)与动力髋螺钉(dynamic hip screw,DHS)在治疗A1、A2和A3型股骨粗隆间骨折的各自特点。方法:股骨粗隆间骨折104例,其中PFN固定33例,男13例,女20例,年龄63～87岁,平均76岁;A1型12例,A2型18例,A3型3例。DHS固定71例中,男29例,女42例;年龄61～92岁,平均74.5岁;A1型32例,A2型34例,A3型5例。对两种术式的平均手术时间、切口长度、失血量、下地负重时间及并发症情况进行比较。结果:平均手术时间PFN(51.5±4.4)min,DHS(68.8±5.9)min;切口长度PFN(9.6±0.9)cm,DHS(15.5±1.5)cm;失血量PFN(179.0±12.9)ml,DHS(269.3±40.0)ml。PFN无髋内翻,DHS髋内翻1例、颈干角变小7例。PFN近端螺钉后退导致髋外侧疼痛6例。结论:DHS与PFN在A1型股骨粗隆间骨折内固定治疗中疗效基本相同。PFN手术损伤小于DHS,且抗张力强,不易并发髋内翻及头旋转,更适合A2、A3型粗隆间骨折。

Objective ：To discuss characters of proximal femoral nail and dynamic hip screw for treating type A1 ,A2,A3 of intertroehanteric fractures. Methods：We review 104 patients with intertrochanteic fractures,33 patients were treated with proximal femoral nail （PFN）, including 13 males and 20 females with an average age of 76 years （ranging from 63 to 87 years ）. 12 cases of type A 1 ; 18 cases of type A2 and 3 cases of type A3 ; and 71 patients were treated with dynamice hip screw （DHS）, including 29 males and 42 females with an average age of 74.5 years （ranging from 61 to 92 years）,32 cases of type A1,34 cases of type A2 and 5 cases of type A3. Comparision in an average time of operations, the length of incision, blood loss, weight loading time and complications between two groups. Results：An average time of operation was （51.5±4.4） min in PFN; （68.8± 5.9 ） min in DHS. The length of incision was （9.6±0.9） em in PFN; （15.5±1.5） em in DHS. The blood loss was （179.0±12.9） ml in PFN; （269.3±40.0） ml in DHS. Varus collapse was none in PFN, 1 case in DHS. The collodiaphyseal angle of 7 cases decreased in DHS. Lateral hip pain caused by proximal screw removal was 6 cases in PEN. Conclusion：The therapeutic effect of DHS and PEN was primitively same in treating type A1 of intertrochanteric fracture. Operative injuries of PFN were less than that of DHS and anti-tonia was more stronger which is more suitable for type A2 and A3 of intertrochateric fractures.