三种不同金属植入物内固定治疗老年股骨转子间骨折99例的随机对照

Comparative efficacy of elderly intertrochanteric fractures treated by three different internal fixations in 99 cases

背景:目前治疗股骨转子间骨折的方法主要为动力髋螺钉,Gamma钉和股骨近端带锁髓内钉3种,究竟何种内固定更为安全、有效、可靠目前仍存在争议。目的:对比3种不同内固定治疗老年股骨转子间骨折的临床疗效。方法:选取石河子市人民医院骨一科2007-10/2009-12收治的股骨转子间骨折患者90例,依据治疗方式的不同,随机分为动力髋螺钉(DHS)组、Gamma钉组和股骨近端带锁髓内钉(PFNA)组。比较3组患者的内固定时间、出血量、住院时间、骨折愈合及并发症发生情况。结果与结论:90例患者均获得随访,随访时间12～26个月,PFNA组总有效率较DHS组和Gamma钉组高,但差异无显著性意义(P>0.05)。PFNA组内固定时间、出血量及住院时间均短于DHS组和Gamma钉组(P<0.05),PFNA组骨痂出现时间和骨折愈合时间与DHS组和Gamma钉组相比差异无显著性意义(P>0.05)。PFNA组内固定并发症明显低于DHS组和Gamma钉组(P<0.05)。提示PFNA对骨折端的血循环影响小和骨质破坏少,固定更为牢靠,是治疗老年股骨转子间骨折较为合理的方法。

BACKGROUND：Treatments for intertrochanteric fractures have three methods：dynamic hip screw（DHS）,Gamma nail and proximal femoral nail anti-rotation（PFNA）.Which one is more safe,effective,and reliable is still controversial.OBJECTIVE：To explore the clinical efficacy of three different internal fixation methods on elderly intertrochanteric fractures.METHODS：According to the different surgical methods,90 elderly patients with intertrochanteric fractures were divided into PFNA group,Gamma nail group and the DHS group.A comparison among the three groups in operative time,blood loss,hospital stay,fractures healing and surgical complications was performed.RESULTS AND CONCLUSION：Totally 90 patients were followed for 12-26 months.The total efficiency of the PFNA group was higher than that of the DHS group and the Gamma nail group,but no significant difference existed（P 0.05）.In the PFNA group,the operation time,blood loss and hospital stay were significantly shorter than those in the DHS group and the Gamma nail group（P 0.05）.Although in the PFNA group the callus formed earlier and fracture healing time were shorter than those in the DHS group and the Gamma nail group,there was no significant difference（P 0.05）.The incidence of postoperative complications during the follow-up was lower in the PFNA group than the DHS group and the Gamma nail group（P 0.05）.PFNA method compromises less vascular support and osseous,and provides more stable fixation,which is a reasonable surgical method for intertorchanteric fractures.