动力髋螺钉和股骨近端防旋钉治疗股骨转子间骨折的疗效比较

Comparative study of dynamic hip screw and proximal femoral nail antirotation for treatment of patients with femoral intertrochanteric fractures

目的探讨应用动力髋螺钉(DHS)和股骨近端防旋钉(PFNA)治疗股骨转子间骨折的临床疗效。方法应用DHS和PFNA治疗股骨转子间骨折患者65例,DHS组37例,PFNA组28例,对两组手术时间、出血量和术后疗效进行分析。结果 DHS组有1例出现内植物感染,有2例螺钉断裂、髋内翻,再次行手术;术后1年29例疗效优良,优良率为78.4%。PFNA组患者未出现术后感染和内固定失败断裂;术后1年24例疗效优良,优良率为85.7%。结论 PFNA是治疗股骨转子间骨折较牢靠、有效的内固定方式,手术创伤小、操作简单、固定牢靠、抗旋转性强、骨折术后并发症少的特点,尤其适合不稳定的股骨转子间骨折。

Objective To study the significance of different internal fixations of intertrochanteric hip fractures by comparing the effects of using dynamic hip screw（DHS） and proximal femoral nail antirotation（PFNA） as implant.Methods The 65 elder patients with intertrochanteric hip fractures were followed up retrospectively.They were treated with the two kinds of operations： DHS 37 cases（group DHS）,and PFNA 28 cases（group PFNA）.The data of each group were collected for statistical analysis on the following aspects： operative time,blood loss,clinical healing time of fractures,intraoperative complications,functional outcome.Results Group DHS had one case implant infection,and 2 cases of screw breakage and hip varus.29 cases got excellent and good results in 1 year.The excellent and good rate was 78.4%.Group PFNA had shorter operative time and clinical healing time,lesser blood loss,better clinical outcome,with no case failure.24 cases got excellent and good results in 1 year.The excellent and good rate was 85.7%.Conclusions PFNA is the kind of stable and effective internal fixations of treating intertrochanteric hip fractures which has the advantage of stable fixation and antirotation with lesser blood loss.It is especially suitable for complex unstable intertrochanteric hip fractures.