DHS、PFN、AFR治疗老年股骨粗隆间骨折的疗效分析

Analysis of Therapeutic Effect of DHS, PFN, AFR in Treating the Aged Intertrochanteric Fractures of the Femur

目的比较采用动力髋螺钉(DHS)、股骨近端锁钉(PFN)和人工股骨头置换(artificial femoral head replacememt,AFR)治疗老年骨质疏松性股骨粗隆间骨折的疗效,探讨老年骨质疏松性股骨粗隆间骨折合理的内固定治疗方法。方法 2007年9月至2011年12月采用动力髋螺钉(DHS)、股骨近端锁钉(PFN)、人工股骨头置换(AFR)3种内固定方法治疗128例老年性骨质疏松性股骨粗隆间骨折患者。比较三组患者手术时间、出血量及术后关节功能情况。结果三组间平均手术时间及术后关节功能无明显差异(P>0.05),PFN组出血量少于DHS、AFR组,差异有显著性(P<0.05),下地时间AFR组明显短于其余两组,差异有显著性(P<0.05)。结论应用DHS、PFN、AFR治疗股骨粗隆间骨折,疗效无明显差异。而AFR可明显减少卧床时间,减少并发症,提高生活质量,是治疗老年性骨质疏松性股骨粗隆间骨折的较理想的手术方法。

Objective To investigate the therapeutic effect of dynamic hip screw （DHS）, proximal femoral nail （PFN）, and artificial femoral head replacement （AFR） in treating the aged intertrochanteric fractures of the femur, and provide reference for reasonable internal fixation treatment. Methods 128 cases of the aged intertrochanteric fractures were divided into 3 groups： the DHS group, the PFN group and the AFR group according to the surgical methods. The operation time, blood loss during operation and postoperative joint function were compared. Results There was no significant difference at the average operation time and postoperative joint function in the three groups （P 0.05）. The blood loss during operation in the PFN group was less than that in the DHS group and AFR group, and the difference was statistically significant （P 0.05）. The time of postoperative walking in the AFR group was shorter than that in the PFN group and DHS group, and the difference was statistically significant （P 0.05）. Conclusions There is no significant difference in the therapeutic effect of DHS, PFN, AFR. AFR is feasible and effective in treatment of aged intertrochanteric fractures of the femur, which can decrease the bed rest time, reduce the complications and improve the quality of life.