两种内固定治疗老年股骨粗隆间骨折比较

The Clinical Results of Traction and Closed Reduction with PFNA Internal Fixation for the Intertrochanteric Fracture in Elder Patients

目的 比较牵引闭合复位股骨近端防旋髓内钉（proximal femoral nail antirotation,PFNA）内固定和传统的切开复位动力髋螺钉（dynamic hip screw,DHS）内固定治疗老年股骨粗隆间骨折的临床疗效.方法 回顾2006年6月至2011年1月我院收治的123 例老年股骨粗隆间骨折患者,其中应用牵引床牵引闭合复位PFNA内固定64 例,男43 例,女21 例,年龄67～95 岁,平均71.8 岁;传统切开复位DHS内固定59 例,男49 例,女10 例,年龄70～82 岁,平均70.3 岁.记录两组患者手术时间、出血量、术后下地活动时间及随访时患髋Harris评分,应用SPSS 11.0统计学软件对相关临床数据进行统计学分析.结果 PFNA组64 例患者中57 例获得随访,DHS组59 例患者中50 例获得随访,术后随访时间14～18个月,平均15.3个月,和传统的切开复位DHS内固定相比,应用牵引床牵引闭合复位PFNA内固定手术时间短,出血少,术后下地活动时间早.结论 和传统的切开复位DHS内固定相比,应用牵引闭合复位PFNA内固定治疗老年股骨粗隆间骨折具有手术时间短、创伤小、出血少、可早期下床活动等优点,在适应证选择得当情况下,两种手术方法均可获得满意临床疗效.

Abstract： Objective To compare the clinical effect of the of closed reduction by traction with PFNA internal fixation and traditional opening reduction with DHS internal fixation for the intertrochanteric fracture in elder patients. Methods From June 2006 to January 2011 ,a total of 123 cases of the intertrochanteric fracture in elder patients were reviewed. 64 cases were treated with closed reduction by traction with PFNA internal fixation. There were 43 males and 21 females,with an average of 71.8 Years （ range 67 -95 years）. 59 cases were treated with traditional opening reduction with DHS internal fixation,49 males and 10 females,with an average of 70.3 years （ range 70 - 82 years）. The operation time, the amount of bleeding, post operative , time to do exercise and Harris score with following-up were recorded and analysized by statistics with SPSS 11.0. Results 57 cases of PFNA group and 50 cases of DHS group were followed up for average 15.3 months（range 14-18months）. PFNA group spent shoter operation time with less bleeding and could do exercise early. Conclusion Compared with traditional opening re- duction with DHS, closed reduction by traction with PFNA internal fixation for the intertrochanteric fracture in eider patients is an effective treatment with adventage of shorter operation time,less trauma,less bleeding and doing exercise early. Two opera- tion can both get satisfying clinical effect if indications choice is correct.