DHS、PFNA和Intertan钉治疗老年股骨粗隆间骨折的效果

The therapy and prognosis of DHS, PFNA and Intertan nail on intertrochanteric fractures of elderly patients

目的 探讨DHS、PFNA和Intertan钉治疗老年股骨粗隆间骨折的效果.方法 选择101例老年股骨粗隆间骨折患者,行DHS固定34例（DHS组）、PFNA固定33例（PFNA组）、Intertan钉固定34例（INTERTAN组）,观察3组手术时间、术中出血量、并发症等,并随访疗效.结果 DHS组手术时间[（85.1±8.9）、（63.1±8.2）、（57.9±9.2）min,F=12.761,P＜0.001]、术中出血量[（350.1±80.2）、（137.5 ±35.4）、（125.2±38.2） ml,F=20.462,P＜0.001]和术后引流量[（125.3±20.4）、69.4±9.2）、（74.6±10.4） ml,F=15.871,P＜0.001]显著高于PFNA组和INTERTAN组.INTERTAN组手术时间、术中出血量低于PFNA组,但差异无统计学意义（P均＞0.05）.DHgS组骨折不愈合率显著高于其他两组（8.82％与0和0,x2=6.092,P=0.047）.DHS组、PFNA组和INTERTAN组的优良率分别为82.4％ （28/34）、87.9％（29/33）、85.3％ （29/34）,差异无统计学意义（x2 =0.591,P＞0.05）.结论 Intertan钉和PFNA手术时间短、抗旋转能力强,术后各种并发症发生率低,较DHS更适用于治疗老年伴有骨质疏松的股骨粗隆间骨折.

Objective To investigate the therapy of DHS,PFNA and Intertan nail for the treatment in elderly patients with intertrochanteric femoral fractures.Methods One hundred and one elderly patients with intertrochanteric fractures were collected.Thirty-four cases of them were undertaken DHS （DHS group）,33 cases for PFNA （PFNA group）,and 34 cases for Intertan nail （INTERTAN group）.Operative time,blood loss and complications were observed.Results The Operative time of patients in DHS,PFNA and Intertan groups were （85.1 ± 8.9） min,（63.1 ± 8.2） min,（57.9 ± 9.2） min respectively and the difference was significant （F=12.761,P〈0.001）.The blood loss amount in DHS group were （350.1 ±80.2）ml,lower that those in PFNA and Intertan groups （（137.5 ± 35.4） ml and （125.2 ± 38.2） ml,F =20.462,P 〈 0.001）.Meanwhile,the postoperative drainage in DHS group was （125.3 ± 20.4） ml,significantly higher than PFNA group and INTERTAN group （（69.4 ± 9.2） ml and （74.6 ± 10.4） ml; F =15.871,P 〈0.001）.Operative time,blood loss amount in INTERTAN group were less than that in PFNA group,but no significant difference （P 〉0.05）.Nonunion in DHS group was significantly higher than the other two groups （8.82% vs 0% and 0%,x2 =6.092,P =0.047）.Excellent rate in DHS group,PFNA group and Intertan group were 82.3% （28/ 34）,87.8% （29/33）,85.3% （29/34） respectively,and there was no significant difference （x2 =0.591,P 〉 0.05）.Conclusion Compared with DHS,Intertan nail and PFNA have advantage of shorter operative time,stronger anti-rotation capability and less various postoperative complication rates,thus they are more suitable for elderly osteoporotic intertrochanteric fracture.