高龄股骨粗隆间骨折手术方案制定研究

Study on the operation plans of femoral intertrochanteric fracture for elderly patients

目的分析研究对高龄股骨粗隆间骨折患者手术治疗的方案，更好地对高龄股骨粗隆间骨折患者进行治疗。方法选择2008年2月～2012年12月我院收治的高龄股骨粗隆间骨折患者共268例为临床研究对象，根据患者的治疗方法将患者分为两组。PFNA组患者共122例，采用防旋型股骨近端髓内钉治疗；DHS组患者共146例，使用动力髋螺钉治疗，观察比较两组手术情况和治疗效果。结果对A1分型的患者，两组治疗方法、手术时间等差异不明显（P〉0．05）；对A2和A3分型的患者，PFNA组患者的患者手术时间、出血量、引流量、手术切口的长度均低于DHS组、术后并发症发生少，手术后功能恢复优于DHS组，差异有统计学意义（P〈0．05）。结论高龄股骨粗隆间骨折患者使用PFNA治疗、DHS治疗，均可以取得一定的治疗效果，其中A1分型患者使用DHS治疗及PFNA效果均较好，而对A2型和A3型的患者，使用PFNA效果更好，医生要根据患者实际情况进行合理的选择。

Objective To analyze and explore the operation plans of femoral intertrochanteric fracture for elderly patients so as to provide better treatment for elderly patients with femoral intertrochanteric fracture. Methods 268 elderly patients with femoral intertrochanteric fracture who were admitted to our hospital from February 2008 to December 2012 were selected as subjects and assigned to two groups according to different treatment methods. 122 patients in the group of PFNA received the treatment of proximal femoral nail anti-rotation（PFNA）; 146 patients in the group of DHS received the treatment of dynamic hip screw（DHS）. The operations and curative effects in the two groups were observed and compared. Results For patients of type A1, the curative methods and operation time in the two groups were not significantly different（P 〉 0.05）; for patients of type A2 and type A3, the operation time, blood loss, volume of drainage and length of operative incision in the group of PFNA were all lower than those in the group of DHS, and the differences were statistically significant（P 〈 0.05）. Conclusion The treatments of PFNA and DHS are both effective for elderly patients with femoral intertrochanteric fracture. The treatments of DHS and PFNA are equally effective for patients of type A1 and the treatment of PFNA is more effective for patients of type A2 and A3. Doctors are suggested to make appropriate choices based on patients＇ actual conditions.