三种内固定方式治疗老年粗隆间骨折疗效比较

A comparison of three fixations in the treatment of intertrochanteric fractures of the elderly

[目的]分析比较应用3种内固定方式治疗老年粗隆间骨折的疗效。[方法]对本院2005年4月～2009年4月应用动力髋(DHS-Ⅰ组)、DHS联合防旋螺钉(DHS-Ⅱ组)、股骨近端髓内钉(PFN组)3种手术方式治疗老年粗隆骨折(EvansⅠ～Ⅳ型)共110例进行回顾性总结分析,其中,DHS-Ⅰ组35例,DHS-Ⅱ组38例,PFN组37例。[结果]本组110例患者中,94例获得随访,随访16～48个月,平均39.7个月。(1)在手术时间、术中出血量方面,PFN组与DHS-Ⅰ组、DHS-Ⅱ组相比,PFN组手术时间短、术中出血少,差异有统计学意义(P<0.05);DHS-Ⅰ组与DHS-Ⅱ组相比,DHS-Ⅰ组虽手术时间短及术中出血量少,但差异无统计学意义(P>0.05);(2)在骨性愈合时间方面,DHS-Ⅰ组较DHS-Ⅱ组、PFN组骨性愈合时间长,且差异有统计学意义(P<0.05);DHS-Ⅱ组较PFN组骨性愈合时间长,但差异无统计学意义(P>0.05);(3)在术后并发症、术后髋关节Harris评分上,PFN组与DHS-Ⅱ组较DHS-Ⅰ组,差异有统计学意义(P<0.05),而PFN组与DHS-Ⅱ组比较,两组虽有差异,但差异无统计学意义(P>0.05)。[结论]DHS联合防旋螺钉与PFN骨性愈合时间短、术后并发症少、髋关节功能恢复好,是治疗股骨粗隆间骨折的良好方式,PFN尤其能减少手术时间和术中出血量,手术损伤小,对于不能耐受较大手术者可用此术式。

[Objective]To compare the clinical results of intertrochanteric fractures of the elderly using DHS（dynamic hip screw）,DHS with anti-revolved screws and PFN（proximal femoral nails）. [Method]A retrospective study was conducted on 110 intertrochanteric fractures（EvansⅠ～Ⅳ） of the elderly treated with DHS（DHS-Ⅰ,35 cases）,DHS with anti-revolved screws（DHS-Ⅱ,38 cases） and PFN（37 cases） in our hospital from April 2005 to April 2009. [Result]Ninty-four cases were followed up successfully with a mean period of 39.7（16 to 48）months.（1）Compared to DHS-Ⅰand DHS-Ⅱ,PFN had a faster procedure and less intra-operative blood loss（P0.05）.However,there were no significant differences between DHS-Ⅰ and DHS-Ⅱ in terms of procedure and intra-operative blood loss（P0.05）.（2）Compared to DHS-Ⅱand PFN,DHS-Ⅰ had a longer time of bone union（P0.05）.No significant difference was found between PFN and DHS-Ⅱ.（3）Compared to DHS-Ⅰ,PFN and DHS-Ⅱhad obvious advantages in terms of postoperative complication rate and recovery of hip function（P0.05）.However,no significant difference was found between PFN and DHS-Ⅱ in term of postoperative complication rate and recovery of hip function（P0.05）. [Conclusion]DHS with anti-revolved screws and PFN are the favorable ways of the treatment of intertrochanteric fractures for the elderly which have obvious advantage in the bone union and postoperative complication as well as good function of the recovery of hip.But PFN has a smaller surgical injury than DHS with anti-revolved screws.Therefore,PFN is much more suitable for patients who do not have greater tolerance of surgical procedure.