IMHS和PFN治疗股骨转子间骨折的生物稳定性比较

Comparison of biological stability between intramedullary hip screw and proximal femoral nail for intertrochanteric fracture

目的比较髓内加压螺钉(IMHS)和近端短重建钉(PFN)治疗股骨转子间骨折的效果。方法 64例股骨转子间骨折患者分为两组,分别采用IMHS与PFN治疗;对比两组手术时间、输血量、行走能力、并发症、病死率等。结果 IMHS组与PFN组手术时间分别为(52.56±12.63)min与(54.74±14.85)min,平均输血量为(1.68±0.31)U与(1.79±0.27)U,术后血红蛋白水平分别为(96.34±16.36)g/L、(97.75±15.87)g/L,两组间上述指标无明显差异(P>0.05)。IMHS组与PFN组术后独立步行、辅助步行、不能步行例数分别为10例(31.25%)、17例(53.13%)、5例(15.63%)与8例(25.00%)、14例(43.75%)、10例(31.25%);IMHS组行走能力优于PFN组(P<0.05)。PFN组并发症发生率(34.38%)高于IMHS组的6.26%(P<0.05),不稳定型患者并发症(21.88%)高于IMHS组的3.13%(P<0.05)。结论 IMHS比PFN能提供更稳定的内固定,并发症率较低,更适合应用于不稳定型的转子间骨折。

Objective To investigate the therapeutic effect of intramedullary hip screw（IMHS）and proximal femoral nail （PFN）for intertrochanteric fracture. Methods 64 patients with intertrochanteric fracture were randomly divided into 2 groups：IMHS group and PFN group,32 cases in each,and IMHS and PFN were used in the operation,respectively;certain data of the operations and the effect were observed and a comparative study was made between the 2 groups. Results The operations lasted averagely for （52. 56 ± 12. 63）minutes in IMHS group and（54. 74 ± 14. 85）minutes in PFN group;the average amount of blood transfusion in operation was（1. 68 ± 0. 31）U in IMHS group and（1. 79 ± 0. 27）U in PFN group;the postoperative haemoglobin level of the patients was（96. 34 ± 16. 36）g/ L in IMHS group and（97. 75 ± 15. 87）g/ L in PFN group;there were no significant differences in above indexes between the two groups（P ﹥ 0. 05）;in IMHS group,10 cases（31. 25% ）could walk independently,17 cases（53. 13% ）could walk with assistive device,and 5 cases（15. 63% ）failed to walk;while in PFN group,8 cases（25. 00% ）could walk independently,14＆amp;nbsp;cases（43. 75% ）could walk with assistive device,and 10 cases（31. 25% ）failed to walk;the Parker-Palmer score of the patients in IMHS group was higher than that of the patients in PFN group（P ﹤ 0. 05）;the occurrence of complications in PFN group（34. 38% ） was significantly higher than that in IMHS group of 6. 26%（P ﹤ 0. 05）;the occurrence of complications in patients with unstable intertrochanteric fracture was 21. 88% in PFN group and 3. 13% in IMHS group（P ﹤ 0. 05）. Conclusions IMHS provides a more stable internal fixation with a lower occurrence of complications than PFN;it is more suitable to be applied to patients with unstable intertrochanteric fracture.