三种固定方式治疗老年不稳定性股骨粗隆间骨折的比较

Clinical comparison of three treatments for unstable trochanteric femoral fractures in elderly

目的对比采用防旋转股骨近端髓内钉（Proximal femoral nail antirotation,PFNA）、动力髋螺钉（Dynamichip screw,DHS）、磷酸钙骨水泥（Calcium phosphates cement,CPC）强化结合DHS三种方法治疗老年不稳定性股骨粗隆间骨折的临床疗效。方法 2008年7月~2010年7月,PFNa手术老年股骨粗隆间不稳定骨折32例（PFNa组）;DHS手术37例（DHS组）;CPC强化结合DHS手术15例（强化组）。记录手术时间、术中出血量、骨折愈合时间、髋部疼痛情况,并测量术后及末次随访时偏心距、颈干角。结果强化组的手术时间延长、术中出血量增大。3组间骨折愈合时间无显著差别。末次随访时髋部疼痛VRS评分DHS组最高,DHS组偏心距改变数值大于其余两组,差别有统计学意义。结论对于老年不稳定性股骨粗隆间骨折,PFNa和CPC强化结合DHS内固定均可有效提高内固定的稳定性,PFNa是首选的内固定方式。

Objective To compare the effect of three methods for treatment of unstable trochanteric femoral fractures in elderly： Proximal femoral nail antirotation（PFNA）;Dynamic hip screw（DHS）;DHS combined with augmentation of Calcium phosphates cement（CPC）.Method 32 patients with unstable trochanteric femoral fractures treated with PFNa as PFNA group,37 patients treated with DHS as DHS group and 15 patients treated with DHS combined with augmentation of CPC as Augmentation group.The results were assessed clinically and radiographically.Result The mean operation time in Augmentation group was the longest and the blood loss was the most among three groups.Union was achieved in all the patients.In the latest follow-up,the highest VRS Score and change of off-set were observed in DHS group.Conclusion Augmentation with CPC or PFNa osteosynthesis improved the stability of unstable trochanteric femoral fractures in elderly.PFNa was preferred method.