股骨近端防旋髓内钉微创治疗老年股骨粗隆间骨折的疗效观察

Proximal femoral intramedullary nail anti-rotation in the minimally invasive treatment of intertrochanteric fractures:recent efficacy observation

[目的]探讨股骨近端防旋髓内钉(PFNA)微创治疗老年股骨粗隆间骨折的近期临床疗效。[方法]分析92例老年股骨粗隆间骨折患者的临床资料,根据不同手术方法分为动力髋螺钉组(DHS组)、股骨近端防旋髓内钉组(PFNA组),分别行动力髋螺钉固定术和股骨近端防旋髓内钉固定术,比较两种手术方法的近期临床疗效及术后并发症的发生情况。同时以成人尸体标本为测试对象,对两种手术后的尸体标本进行生物力学测试并作比较。[结果]92例均获得9～24个月的随访,平均15个月。PFNA组术后并发症发生率比DHS组低,有统计学意义(P<0.05)。PFNA组手术时间、出血量、愈合时间比DHS组低,有统计学意义(P<0.05)。DHS组和PFNA组优良率分别为84.1%、85.5%,组间疗效差异无统计学意义(P>0.05)。[结论]闭合复位小切口股骨近端防旋髓内钉(PFNA)微创治疗老年股骨粗隆间骨折近期疗效与DHS相当,但术后并发症发生率明显低于DHS。

[ Objective] To explore the recent clinical efficacy of proximal femoral intramedullary nail anti-rotation （PFNA） in minimally invasive treatment of intertrochanteric fractures. [ Method] A total of 92 cases of iutertrochanteric fractures in patients with clinical data were analyzed. According to the different surgical techniques, patients were divided into dynamic hip screw group （ DHS group） and proximal femur anti-spin intramedullary nail group （ PFNA group）, respectively. The dynamic hip screw and external fixation, and proximal femur anti-spin intramedullary nail fixation were carded out respectively. The re- cent clinical efficacy and postoperative complications were compared between two groups. Adult cadavers were used and also compared for biomechanical testing after surgery. [ Result ] All 92 cases were followed up for 9 to 24 months, with an average of 15 months. Incidence of postoperative complications in PFNA group was higher than in DHS group, with significant difference （P 〈 0.05）. The operative time, amount of bleeding, healing time in PFNA group were lower than in DHS group, with significant difference （P 〈 O. 05 ）. Good and excellent outcomes rate was 84.1% and 85.5 % in DHS and PFNA groups, without significant difference （P 〉 0.05）. [ Conclusion] Both two methods could acquire good recent efficacy, but complication rate in PFNA group is lower than in DHS group.