动力髋螺钉联合防旋阻挡钉与股骨近端髓内钉治疗不稳定型股骨粗隆间骨折的对比研究

A comparison of the DHS combined with antirotation screw,PFN and DHS in the treatment of unstable femoral intertrochanteric fracture

[目的]探讨动力髋螺钉(DHS)、联合防旋阻挡钉与股骨近端髓内钉(PFN)治疗不稳定型股骨粗隆间骨折的临床效果。[方法]入选90例老年不稳定型股骨粗隆间骨折患者,随机分为DHS联合防旋阻挡钉组、PFN组和DHS组实施内固定手术。术后随访时间为12～24个月。从切口长度、手术时间、术中透视时间、术中出血量、住院时间、术后功能恢复时间及术后并发症方面比较三组的临床效果。[结果]PFN组在切口长度、术中出血量、早期负重时间、术后3个月功能恢复等方面明显优于DHS联合防旋阻挡钉组和DHS组(P<0.05),在住院时间、术后并发症等方面三组无统计学差异。[结论]PFN具有良好的生物力学稳定性,可以作为不稳定型股骨粗隆间骨折的首选内固定装置;DHS联合防旋阻挡钉重建股骨后内侧结构,也是不稳定型粗隆间骨折的良好选择;单纯DHS治疗不稳定型粗隆间骨折,失败率较高,但仍是内侧结构稳定的粗隆间骨折的标准术式。

[ Objective]To explore the effect of the treatment of femoral intertrochanteric fractures using the DHS combined with antirotation screw, PFN and DHS. [ Method] Ninety elder patients with unstable femoral intertrochanteric fracture were randomized to be treated with a DHS combined with antirotation screw,a PFNA or a DHS,and followed up for 12 -24 months,out- comes and complications of the three groups were compared. [ Result] The outcomes of the group PFN were better than the other two in the length of incision, blood loss, time of mobilization with aid and walking ability 3 months after surgery （ P 〈 0.05 ）. There were no significant differences among the three groups in hospital stay and complications. [ Conclusion ] PFN is the first choice for the unstable femoral intertrochanteric fracture, and the DHS combined with antirotation screw is also a useful technique. DHS is still the standard device for stable femoral intertrochanterie fracture.