股骨近端防旋髓内钉与动力髋螺钉治疗老年股骨转子间不稳定骨折疗效比较

Efficacy comparison of proximal femoral nail antirotation and dynamic hip screws for the treatment of the elderly with unstable intertrochanteric fractures

目的：评估闭合复位后小切口股骨近端防旋髓内钉（PFNA）固定与动力髋螺钉（DHS）固定治疗老年人股骨转子间不稳定骨折的临床疗效。方法182例62岁以上不稳定型转子间骨折患者中，采用PFNA固定109例、DHS固定73例，比较两组切口大小、手术时间、术中失血量、术后并发症和患髋关节的Harris评分。结果患者均获随访，时间12～18个月。切口长度：DHS组为5～12（8.6±1.7）cm，PFNA组为3～5（3.8±0.6）cm，P＜0.05。手术时间：DHS组为55～120（71.6±15.8）min，PFNA组为35～70（45.2±9.6）min，P＜0.05。出血量：DHS组为250～800（358.2±42.5）ml，PFNA组为80～300（109.6±17.1）ml，P＜0.05。骨折愈合时间：DHS组为17～30（19.4±10.3）周，PFNA组为15～27（17.1±6.6）周，P＜0.05。术后并发症及输血情况：DHS组术后2周内死亡3例，出现下肢深静脉栓塞2例，术后输血31例，鹅头钉穿出股骨头8例，骨折不愈合3例；PFNA组术后2周内死亡1例，出现下肢深静脉栓塞0例，术后输血23例，鹅头钉穿出股骨头1例，骨折不愈合2例。两组比较差异有统计学意义（P＜0.05）。Harris评分：PFNA组明显优于DHS组（P＜0.05）。结论与DHS固定方法比较，PFNA治疗老年不稳定股骨转子间骨折具有切口小、出血量少、手术时间短、骨折愈合快、并发症发生率低、术后早期患髋功能好等优点。

Objective To evaluate the clinical efficacy of proximal femoral nail antirotation （PFNA）and dynamic hip screws （DHS）in the treatment of the elderly with unstable intertrochanteric fractures.Methods All 182 cases over 62 years old with unstable intertrochanteric fracture patients,109 cases were fixed with PFNA,the other 73 cases were fixed with DHS.The two groups were compared with incision size,operative time,intraoperative blood loss, complications and hip Harris score.Results All the cases were followed from 12 to 18 months.The incision size in DHS group was 5-12（8.6 ±1.7）cm,which in PFNA group was 3-5（3.8 ±0.6）cm （P〈0.05）;the operative time in DHS group was 55-120（71.6 ±15.8 ）minutes,which in PFNA group was 35-70（45.2 ±9.6）minutes（P〈0.05）;the intraoperative blood loss in DHS group was 250-800（358.2 ±42.5）ml,which in PFNA group 80-300（109.6 ±17.1）ml（P〈0.05）;the fracture healing time in DHS was 17-30（19.4 ±10.3）weeks,which in PF-NA group was 15-27（17.1 ±6.6）weeks（P〈0.05）. Complication and blood transfusion：In DHS group,3 cases died in two weeks after the operation,2 cases occurred deep vein thrombosis,3 1 cases were given blood transfusion, 8 cases occurred screw piercing,3 cases occurred bone nonunion.Meanwhile,in PFNA group,1 case died in two weeks after the operation,no case occurred deep vein thrombosis,23 cases were given blood transfusion,1 case oc-curred screw piercing,2 cases occurred bone nonunion.Harris scores in PFNA group were significantly better than that in DHS group （P〈0.05 ）.Conclusions Compared with DHS in the treatment of elderly patients with unstable intertrochanteric fractures,PFNA has a smaller incision size,less bleeding,shorter operative time,shorter fracture healing time,lower incidence of serious complications and better hips functional in the early postoperation.