Gamma-Ⅲ与PFNA钉治疗不稳定性股骨粗隆间骨折的对比研究

Comparison Studies of Proximal Femoral Nail Antirotation and Gamma-Ⅲ Nail in Treatment of Unstable Femoral Intertrochanteric Fracture

目的探讨股骨近端防旋髓内钉(PFNA)与Gamma-Ⅲ钉治疗不稳定性股骨粗隆间骨折(IFF)的临床疗效。方法选取菏泽市立医院骨科住院的IFF患者86例,根据不同的手术方法分为PFNA组(42例)和Gamma-Ⅲ钉组(44例)。比较两组患者的手术操作时间、术中出血量、患者的住院时间和骨折的临床愈合时间,并观察两组患者的术后并发症。结果所有患者的伤口均一期愈合,未出现伤口严重感染和皮缘坏死;PFNA组和Gamma-Ⅲ钉组的手术操作时间分别为(70.0±16.5)min、(82.5±22.5)min,术中出血量分别为(120±30)mL、(150±40)mL,骨折愈合时间分别为(13.2±2.5)周、(14.5±2.0)周,两组比较差异均有统计学意义(P<0.05),两组患者住院时间比较差异无统计学意义(P>0.05);Gamma-Ⅲ钉组和PFNA组的髋关节功能优良率分别为88.6%和88.1%,Gamma-Ⅲ钉组和PFNA组的术后并发症发生率分别为6.8%和4.8%,两组比较差异均无统计学意义(P>0.05)。结论 PFNA与Gamma-Ⅲ钉均可作为治疗老年不稳定性IFF的理想方法,PFNA手术操作更简单,手术创伤相对小,更具有优势。

Objective To investigate the clinical efficacy of proximal femoral nail antirotation（PFNA） and Gamma-Ⅲ nail in treating unstable intertrochanteric femoral fracture（IFF）.Methods Eighty-six patients with IFF hospitalized in Department of Orthopedics of Heze City Hospital were selected,and divided into PFNA group with 42 cases and Gamma-Ⅲ nail group with 44 cases according to the different operation mannersThe operation time,intraoperative bleeding,hospitalization time and fracture healing time of the two groups were compared,and the postoperative complications were observed.Results All patients with wound healed well,there was no severe infection or skin necrosis.The operation time of PFNA group and Gamma-Ⅲ nail group was respectively（70 ± 16.5） min,（82.5 ± 22.5） min,amount of intraoperative bleeding was respectively（120 ± 30） mL,（150 ± 40） mL,fracture healing time was respectively（13.2 ± 2.5） weeks,（14.5 ± 2.0） weeks,the differences were statistically significant（P 0.05）.The hospitalized time of the two groups was not statistically significantly different（P 0.05）.The excellent rate of hip function of Gamma-Ⅲ nail group and PFNA group was 88.6% and 88.1% respectively,and the incidence of postoperative complications was 6.8% and 4.8% respectively,the differences between the two groups were not statistically significant（P 0.05）.Conclusion PFNA and Gamma Ⅲ nail can be both used as an ideal method in treating senile unstable IFF,while PFNA operation is more simple with relatively small trauma,which means more advantages.