DHS、LPFP与PFN治疗老年人股骨粗隆间骨折的前瞻性对比研究

Prospective Study of DHS,LPFP and PFN for Treatment of Elder Patients with Femoral Intertrochanteric Fracture

目的对采用动力髋螺钉(DHS)、股骨近端锁定钢板(LPFP)、股骨近端带锁髓内钉(PFN)治疗高龄股骨粗隆间骨折患者的进行对比分析,探讨其疗效。方法回顾分析2004年2月～2008年2月收治的并得到随访的112例老年人股骨粗隆间骨折患者,分别采用DHS(A组)、LPFP(B组)、PFN(C组)进行治疗,从手术时间、术中出血量、术中X线透视次数、术后引流量、骨折愈合时间、术后并发症、住院费用、术后髋关节Parker功能评分、Barthel生活指数等方面进行分析比较。结果在手术时间、术中出血量、术中X线暴露次数、术后引流量、骨折愈合时间等方面A组与B、C组比较有明显差异(P<0.05),即B、C组与A组相比,手术时间短、术中出血量少、术后引流量少、骨折愈合时间短,但术中X线暴露次数增加、住院费用明显增高,有统计学意义((P<0.05)。在术后髋关节功能评分、Barthel生活指数上A组与B、C组相比较,A组较差(P<0.05),但术后并发症上无明显差异(P>0.05)。结论对于EvensⅠ型股骨粗隆间骨折应用三种内固定方式均可取得较好效果,对EvensⅡ型骨折,适用用PFN、LPFP,也可用DHS。对于EvensⅢ、Ⅳ型股骨粗隆间骨折,最适用PFN、也可用LPFP,对于逆粗隆间骨折及大粗隆冠状面骨折不可用DHS,可用LPFP,最好用PFN。

Objective To study the significance of internal fixations of intertrochanteric hip fractures in elder patients by comparing the effects of various kinds of internal fixations. Methods The 269 eider patients with intertrochanteric hip fractures from July 2004 to February 2008 were followed up. They were treated with the four kinds of operations respectively： dynamic hip screw （group A）, locking proximal femurs plate （LPFP, group B）, proximal femoral nail （PFN, group C）.The data of each group were collected for statistical analysis on the following aspects： operative time, blood loss, fluoroscopy exposures, drainage, clinical healing time of fractures, intrraoperative complications, functional outcome （Harris Hip Score）.Results The differences of the operative time, blood loss, fluoroscopy exposures, drainage and clinical healing time between group A and group B, C were statistical significance（P〈0.05）.Compared with group A,group B, C had shorter operative time and clinical healing time, fewer blood loss and drainage, but more fluoroscopy exposures. No differences of intraoperative complications between group A, B, C （P〉0.05）. The differences of functional outcome （Parker Hip Score）, Barthel Score between group A and B, C were of statistical significance（P〈0.05）, group A was less satisfactory outcome. Conclusion For Evens I fracture, DHS, LPFP and PFN are all applicable.For Evens Ⅱ , Ⅲ ,PFN or LPFP are suitable. For Evens Ⅲ,Ⅳ, PFN are suitable. For reversed intertrochanteric fracture, PFN and LPFP are suitable. For the intertrochanteric fracture plane showing a coronal position,DHS can not be used, but LPFP can be used, and PFN are most suitable.