DHS与PFNA在老年股骨粗隆间骨折治疗中的疗效对比分析

Comparative Analysis of DHS vs PFNA in the Treatment of Senile Intertrochanteric Fracture ofFemur

【目的】探讨动力髋螺钉（DHS）及防旋型股骨近端髓内钉（PFNA）两种内固定方式治疗老年（〉60岁）股骨粗隆间骨折的临床疗效。【方法】将符合标准的75例老年股骨粗隆间骨折患者随机分成两组，DHS组（37例）采用DHS内固定治疗，PFNA组（38例）PFNA内固定治疗，比较两组疗效及并发症发生率。【结果】PFNA组的手术时间和术中出血量明显少于DHS组，切口长度也明显短于DHs组，其差异有统计学意义（P〈0．05），但术后骨折愈合时间比较差异无统计学意义（P〉0．05）；DHS组并发症发生率29．73％显著高于PFNA组的10．53％，其差异有统计学意义（P〈0．05）；DHS和PFNA治疗A1、A2-1类型骨折的优良率与术后骨折愈合时间比较差异无统计学意义（P〉0．05），但PFNA治疗A2-2、A2-3、A3类型骨折的优良率显著高于DHS，其差异有统计学意义（P〈0．05）。【结论】PFNA内固定治疗老年股骨粗隆间骨折手术时间短，术中出血少，安全有效，尤其适用于骨质疏松患者，值得临床推广应用。

[Objective]To explore the clinical efficacy of two kinds of internal fixation methods dynamic hip screw（DHS） and proximal femoral anti-rotation nail（PFNA） for the treatment of senile intertrochanteric frac- ture of femur. [Methods] A total of 75 elderly patients with intertrochanteric fracture of femur in accordance with the standard were randomly divided into two groups. DHS group（ n =37） was treated with DHS, while PFNA group（ n=38） was treated with PFNA. The efficacy and complications were compared between two groups. [Results] The operation time and intraoperative blood loss volume in PFNA group were obviously less than those in DHS group, and the length of incision in BFNA was also obviously shorter than that in DHS group, and there were significant difference（ P 〈0.05）, while there was no significant difference in the frac- ture healing time between two groups（ P〉0.05）. The incidence of the complications in DHS group was 29.73%, which was markedly higher than that in PFNA group（10.53%）, and there was significant difference （ P 〈0.05）. There was no significant difference in the excellence rate and postoperative healing time between DHS and PFNA for the treatment of A1 and A2-1-type fractures（ P 〉0.05）, while the excellence rate of PF- NA for the treatment of A2-2, A2-3 and A3-type fractures were markedly higher than those of DHS, and there were significant differences（ P 〈0.05）. [Conclusion] PFNA internal fixation for the treatment of senile inter- trochanteric fracture of femur has short operation time and less blood loss volume, and is safe and effective, especially for patients with osteoporosis. Therefore, it is worthy of being widely applied in the clinical practice.