动力髋螺钉与股骨近端抗旋髓内钉治疗转子间骨折的比较

Effects of dynamic hip screw and proximal femoral nail antirotation fixation in the treatment of intertrochanteric fracture of femur

背景:转子间骨折主要有两种固定方式,一是髓外固定的钉板系统,以动力髋螺钉为代表;另一种是髓内固定的髓内钉系统,以股骨近端抗旋髓内钉为代表。目的:比较动力髋螺钉与股骨近端抗旋髓内钉治疗老年股骨转子间骨折的疗效。方法:回顾性分析2008-01/2010-12山西省人民医院骨科收治的老年股骨转子间骨折患者58例。分别采用动力髋螺钉及股骨近端抗旋髓内钉两种内固定方式置入治疗。结果与结论:动力髋螺钉组平均随访13个月,股骨近端抗旋髓内钉组平均随访11个月。随访期内两组均达骨性愈合。置入内固定治疗后动力髋螺钉组完全负重时间、骨折愈合时间较股骨近端抗旋髓内钉组延长(P<0.05);末次随访时Parker-Palmer评分两组相比,差异无显著性意义(P>0.05)。动力髋螺钉组主钉松动退出1例,钢板断裂1例;所有患者无伤口感染、内固定物切割、髋内翻等并发症出现,最终骨折愈合。提示两种内固定治疗转子间骨折均可达到良好的治疗效果。股骨近端抗旋髓内钉比动力髋螺钉内固定可更早负重,骨折愈合时间短。

BACKGROUND：There are two main fixation methods for the treatment of intertrochanteric fractures,one is the extramedullary fixation screw-plate system which represented by the dynamic hip screw（DHS）,and another one is the intramedullary fixation nail system which represented by the proximal femoral nail antirotation（PFNA）.OBJECTIVE：To compare the effect of PFNA and DHS in treatment of intertrochanteric fracture in old people.METHODS：In this retrospective study,a series of 58 patients with intertrochanteric hip fractures were reviewed from January 2008 to December 2010 in the Department of Orthopedics,Shanxi Provincial People＇s Hospital.The patients were treated with PFNA and DHS respectively.RESULTS AND CONCLUSION：The mean follow-up time was 13 months in DHS group and 11 months in PFNA group,and all the patients in the two groups achieved bone healing.The full weight-bearing time and the fracture healing time in DHS group were longer than those in the PFNA group（P 0.05）;there was no significant difference of the Parker-Palmer＇s score in two groups（P 0.05）.And in the DHS group,nail loose occurred in 1 case,plate fracture in 1 case;all patients were ultimately healed without wound infection,internal fixation cutting,coxa vara and other complications.For the treatment of intertrochanteric femoral fracture,both DHS and PFNA fixation could achieve a good outcome,however,the patients in PFNA fixation group get full weight-bearing stepping and fracture healing earlier than the ones of DHS fixation group.