4种手术方法治疗老年骨质疏松性股骨转子间骨折疗效分析

Four kinds of operation method to treat senile osteoporosis subtrochanteric femoral fractures

目的比较DHS、股骨近端解剖型锁定钢板、Gamma钉和PFNA 4种内固定方法治疗老年骨质疏松性股骨转子间骨折的临床效果。方法对108例老年骨质疏松性股骨转子间骨折患者分别采用DHS(30例)、股骨近端解剖型锁定钢板(18例)、Gamma钉(22例)和PFNA(38例)治疗,比较4组手术情况、术后并发症、骨折愈合时间及临床疗效。结果 108例患者均获得随访,时间6～36个月。4组内固定方法手术时间、术中出血量比较差异有统计学意义(P<0.05)。术后并发症比较差异无统计学意义(P>0.05)。骨折愈合时间:DHS组(13.0±1.9)周,锁定钢板组(13.5±3.3)周,Gamma钉组(12.5±2.0)周,PFNA组(12.0±2.8)周,差异无统计学意义(P>0.05)。根据髋关节Harris评分标准评定功能:DHS组(85.6±5.3)分,优良率86.7%;锁定钢板组(86.1±6.5)分,优良率83.3%;Gamma钉组(88.2±4.2)分,优良率90.9%;PFNA组(89.3±3.8)分,优良率92.1%;4组比较差异无统计学意义(P>0.05)。结论对于稳定型骨折应用4种内固定方法皆可;对于不稳定型骨折宜选用Gamma钉和PFNA;PFNA尤其适用于不稳定型骨质疏松性股骨转子间骨折。

Objective To compare the effect of DHS,with anatomical proximal femoral locking plate,Gamma nail and PFNA internal fixation methods for the treatment of senile osteoporotic femoral intertrochanteric fractures.Methods 108 cases of senile osteoporotic femoral intertrochanteric fractures were treated with DHS（n=30）,anatomical proximal femoral locking plate（n=18）,Gamma nail（n=22） and PFNA（n=38）.The effects were compared between the 4 groups of operation,postoperative complications,time of fracture healing and clinical curative effect.Results 108 cases were followed up for 6~36 months.4 groups of internal fixation methods in operation time,intraoperative blood loss had a significant difference（P〈0.05）.Postoperative complications were no statistically significance（P〉0.05）.Fracture healing time： group DHS（13±1.9） weeks,the locking plate group（13.5±3.3） weeks,Gamma nail group（12.5±2.0） weeks,PFNA group（12±2.8） weeks,the differences were not statistically significant（P〉0.05）.According to Harris hip evaluation criteria function： group DHS（85.6±5.3） points,excellent-good rate was 86.7%;the locking plate group（86.1±6.5）,excellent-good rate was 83.3%;Gamma nail group（88.2±4.2）,excellent-good rate was 90.9%;PFNA group（89.3±3.8）,excellent-good rate was 92.1%;the difference was not statistical significant（P〉0.05）.Conclusions For stable fractures,using 4 kinds of internal fixation can be equally effective;for the unstable fracture,PFNA and Gamma nail provide better results;PFNA is especially suitable for unstable intertrochanteric osteoporotic fractures.