两种不同内固定方法治疗股骨粗隆间骨折的临床效果比较

目的探讨不同内固定治疗方法即髋动力螺钉（DHS）和抗旋转髓内钉（PFNA）在治疗股骨粗隆间骨折的临床效果。方法本院骨外科收治的股骨粗隆间骨折的患者共92例，随机分为2组，其中采用髋动力螺钉组50例，采用抗旋转髓内钉组42例，对两组患者手术过程中的指标和术后恢复情况进行分析。结果PFNA组手术时间明显缩短，术中出血量也明显减少，经比较，差异有统计学意义（P〈0．05）。PFNA组患者恢复至行走的时间、最终骨折愈合时间短于DHS组，经比较，差异具有统计学意义。两组患者中稳定性股骨粗隆间骨折（EvansⅠ型）患者恢复的优良率经比较，差异无统计学意义；不稳定性股骨粗隆间骨折（EvansⅡ、Ⅲ型、逆粗隆型）患者恢复的优良率比较显示，PFNA组优良率高于DHS组，差异有统计学意义。结论PFNA组与DHS组比较显示在治疗股骨粗隆间骨折中具有手术时间短，出血量少，愈合快，在治疗不稳定性骨折中具有可大的优势。

Objective To explore different internal fixation method ： the dynamic hip screws （DHS） and the proximal femoral nail antirotation （PFNA） for the treatment of intertrochanteric fractures. Methods Operations of intertrochanteric fractures of the 92 cases were retrospectively studied, patients were divided into two groups, dynamic hip screws in 50 cases, while rotate intramedullary nailing group with 42 cases, procedure related index and postoperative recover situation of two groups were analyed. Results PFNA group operation time significantly shortened, peri -operative bleeding also significantly reduced, a statistically significant difference （ P 〈 0. 05 ） was found by comparison,. Time for PFNA groups of patients recovered to walking, and fracture healing is shorter than DHS group. No significant difference were found between two groups of patients in stable intertrochanteric fractures （Evans Ⅰ type）. The good recovery rate of PFNA group was better than DHS group in none stable intertrochanteric fractures （ Evans Ⅱ , Ⅲ type, inverse thick long type） patients. Conclusion Compared with DHS, PFNA has advantages in shorter operative time, less blood loss and faster recovery, compared with DHS in the treatment of none stable intertrochanteric fractures.