DHS和PFNA固定治疗老年股骨粗隆间骨折疗效比较

目的分析比较应用2种内固定方式治疗老年粗隆间骨折的疗效。方法对2008年2月～2010年2月应用动力髋螺钉(DHS组)、股骨近端螺旋刀片抗旋髓内钉(PFNA组)2种手术方式治疗老年股骨间粗隆骨折(EvansⅠ～Ⅳ型)共43例进行回顾性总结分析,其中DHS组21例,PFNA组22例。结果本组43例患者中,42例获得随访。与DHS相比较,PFNA组手术时间短、术中出血少,差异有统计学意义(P<0.05);在骨性愈合时间方面,PFNA组骨性愈合时间短,但差异无统计学意义;DHS组出现1例髋内翻;2组均无股骨头颈切出、再发骨折发生;2组在术后并发症、术后髋关节Harris评分方面,差异无统计学意义。结论 DHS与PFNA两种固定方法骨性愈合时间短、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,尤其是PFNA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首选。

Objective To compare the clinical results of intertrochanteric fractures of the elderly using DHS（dynamic hip screw） and PFNA（proximal femoral nail anti-rotation）. Methods A retrospective study was conducted on 43 intertrocbanteric fractures （Evans Ⅰ - Ⅳ） of the elderly treated with DHS（21 cases） and PFNA（22 cases） in our hospital from February 2008 to February 2010. Results Forty-two cases were followed up successfully. Compared to DHS, PFNA had a faster procedure and less intra-operative blood loss （P〈 0.05）. However, there were no significant differences between DHS and PFNA in time of bone union, postoperative complication rate and recovery of hip function. Conclusion DHS and PFNA 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 PFNA has a smaller surgical injury than DHS. Therefore, PFNA is much more suitable for patients who do not have greater tolerance of surgical procedure.