PFNA与DHS+TSP治疗股骨粗隆间不稳定型骨折临床疗效对比分析

Clinical outcome comparison of treating unstable intertrochanteric fracture by proximal femoral nail anti-rotation with dynamid hip screw and trochanter stabilizing plate

[目的]比较PFNA(股骨近端防旋髓内钉proximal femoral nail anti-rotation)与DHS+TSP(动态髋螺钉及转子稳定钢板dynamic hip screw+trochanter stablizing plate)治疗股骨粗隆间不稳定型骨折的临床疗效。[方法]回顾分析2004年1月～2008年8月本院收治的47例股骨粗隆间不稳定型骨折(AO分型A2型)病例,其中24例采用PFNA内固定,23例采用DHS+TSP内固定,对比两组患者的手术时间、术中失血量、术后卧床时间、术后关节功能,并用Harris评分系统进行评分,随访患者的骨折愈合情况,术后1周,3、6个月,1年复查。评价2种术式的疗效,分析手术相关并发症的原因。[结果]PFNA组平均手术时间(113±29)min,术中出血量(135±85)ml,术后Harris评分平均(89±3)分,患者中有1例头颈螺旋刀片切割股骨头的病例,无髋内翻病例,骨折均骨性愈合,平均愈合时间(5±1)个月。DHS+TSP组平均手术时间(156±35)min,术中出血量(429±266)ml,术后Harris评分平均(84±6)分,有1例患者术后因肺部感染死亡,2例出现头颈钉滑移,保守治疗后好转。PFNA较DHS+TSP治疗不稳定型股骨粗隆间骨折,手术时间短,P=0.002(P<0.05),卧床时间短,P=0.000(P<0.05),出血量少,P=0.001(P<0.05),髋关节Harris评分更高,P=0.006(P<0.05)。[结论]PFNA是治疗股骨粗隆间不稳定型骨折的良好固定材料,在治疗上较DHS+TSP具有操作简单、创伤小、骨折固定牢固、并发症少及术后患者可早期离床负重、髋关节功能恢复更好等优点,是一种治疗股骨粗隆间骨折的理想方法。

[ Objective] To compare the clinical outcome of treating the unstable intertrochanteric fracture by PFNA （proxi- mal femoral nail anti-rotation） with DHS ＋ TSP （dynamic hip screw ＋ trochanter stablizing plate ）. [ Method ] Forty-seven pa- tients admitted for unstable intertrochanteric fracture （AO classicification A2 type） who could be followed up during January 2004 and August 2008 were reviewed. Twenty-four patients were treated with PFNA as internal fixation, while the other twenty- three patients were treated with DHS ＋ TSP as internal fixation. The operate time, blood loss during the operation, the time of lying in bed post operation, the function of the hip joint were compared, the function were compared by Harris assessment sys- tem. The condition of the bone union were obeserved. Patients were followed up at 1 week, three months, six months and 1 year post operation. The clinical outcome was assessed and the reason of the complications of each patient was analyzed. [ Result] The mean operate time of PFNA group were 113 ± 29 min, the mean blood loss during the operation were 135 ±85ml, the mean Harris score post operation were 89 ± 3, one patient complained of cutting out of the femoral head by the blade, no patients com- plained for varus of hip joint, the patients all got bone union, the mean union time were 5 ± 1 months. The mean operate time of DHS ＋ TSP group were 156 ± 35 min, blood loss during the operation were 429 ± 266 ml, the mean post operation Harris score were 84 ± 6. One patient died of pulmonary infection post-operation and two patients complained about over slide of the compress nail in the femoral head which were treated by postpone the time for the patient to leave bed. For unstable intertrochanteric frac- ture, compared with DHS ＋ TSP, the operate time was shorter P = 0. 002 （P 〈 0.05 ）, the time of lying in bed was shorter P = 0. 000 （P 〈 0.05 ）, the blood loss during operation was less in the group of using PFNA P = 0. 001 （ P 〈 0.05 ）, the hip joint Harris score was higher P =0. 006 （P 〈 0.05 ）. [ Conclusion] PFNA is a good choice to treat unstable intertrochanteric frac- ture. It is superior to DHS ＋ TSP. It is easy to use, with minimal soft tissue injured, stable in fixation of the bone fragment, and with few complications and the patient could return to walk soon after the operation.