LPFP及PFN治疗老年股骨粗隆间骨折的方法比较

Comparison of Locking Proximal Femur Plates and Proximal Femur Nail for Treatment of Femoral Intertrochanteric Fractures(AO type A3) in Elderly Patients

目的对老年人股骨粗隆间骨折(AO分型A3型)采用股骨近端锁定钢板(locking proximal femul plate,LPFP)、股骨近端带锁髓内钉(proximal femur nail,PFN)两种内固定方式进行对比分析,探讨其疗效。方法回顾分析66例老年人AO分型A3型的股骨粗隆间骨折患者,36例采用LPFP治疗(LPFP组),30例采用PFN(PFN组)进行治疗,从手术时间、术中出血量、骨折愈合时间、术后并发症、住院费用、术后Harris髋关节评分等方面进行分析比较。结果在住院费用等方面,LPFP组与PFN组比较有明显差异(P<0.05),LPFP组与PFN组相比,住院费用低。在手术时间、术中出血量、术后并发症、骨折愈合时间、术后Harris髋关节功能评定优良率等方面两组无明显差异(P>0.05)。Harris髋关节功能评定优良率:LPFP组88.9%(32/36),PFN组86.7%(26/30)。结论对老年人AO分型A3型的股骨粗隆间骨折采用股骨近端锁定钢板(LPFP)和股骨近端带锁髓内钉(PFN)均能得到良好效果,LPFP组费用低,对骨折线和PFN拉力螺钉走向重合、以及合并冠状面骨折及大粗隆骨折的病例,采用LPFP固定更牢靠。

Objective To compare and analyze the clinical effect of locking proximal femur plates （LPFP） and proximal femur nail （PFN） for treating intertrochanteric fractures in eldly patients. Methods 66 patients with inter- trochanteric fractures （AO type A3）in elderly patients were reviewed. 36 patients were treated with LPFP. 30 patients were treated with PFN. The operation time ,intraoperative blood loss ,clinical healing time of fracture, postoperative complications ,hospital expense and the excellent and good rate in Harris score were recorded. Results There was no significant difference between the two groups in the mean operation time,intraoperative blood loss and clinical healing time of fracture,postoperative complications （P〉0.05）. The hospital expense was （22 370±3 840） yuan in LPFP group and （18 728±1 720） yuan in PFN group （P〈0.05）. The excellent and good rate in Harris score was 88.9% （32/36）in LPFP group,and 86.7% （26/30） in PFN group. Conclusion LPFP and PFN are favorable for treating se- nile femoral intertrochantericfractures. LPFP has lower hospital expense. If there were overlap of fracture line and PEN lag screw,coronal fracture or fracture of the greater trochanter ,LPFP provides better fixation.