3种内固定治疗老年不稳定股骨粗隆间骨折的疗效比较

Clinical efficacy of three internal fixations in treating unstable femoral intertrochanteric fracture in elder patients

目的比较95°髁动力加压钢板(DCS)、股骨近端防旋髓内钉(PFNA)以及第4代髓内钉(Inter Tan)治疗老年不稳定股骨粗隆间骨折的临床疗效。方法 111例股骨粗隆间骨折随机随机采用DCS、PFNA、Inter Tan内固定,每组37例。比较3组手术时间、术中出血量、手术质量、骨折愈合时间及并发症情况,末次随访时疗效采用髋关节功能Harris评分标准评定。结果 3组手术时间差异有统计学意义(F=41.530,P<0.001),且PFNA组较DCS组和Inter Tan组短,Inter Tan组较DCS组短。3组术中失血量差异有统计学意义(F=244.890,P<0.001);且PFNA组较DCS组和Inter Tan组少,Inter Tan组较DCS组少。3组手术质量比较差异无统计学意义(χ2=1.631,P=0.442)。3组骨折愈合时间差异有统计学意义(F=19.765,P<0.001);PFNA组与Inter Tan组骨折愈合时间差异无统计学意义(P>0.05),但均明显低于DCS组(P<0.05)。3组髋关节功能Harris评分差异有统计学意义(F=3.691,P=0.028);PFNA组与Inter Tan组Harris评分差异无统计学意义(P>0.05),但均明显高于DCS组(P<0.05)。DCS组并发症发生率明显高于PFNA组及Inter Tan组。结论对于老年不稳定股骨粗隆间骨折,虽然DCS内固定手术质量较髓内钉固定好,但是在术后并发症及功能恢复方面较PFNA和Inter Tan内固定差。PFNA内固定操作简单,手术时间短。Inter Tan内固定抗旋转能力强,退钉率较低。

Objective To compare the clinical efficacy among of dynamic condylar screw（DCS）, proximal femoral nail antirotation（PFNA） and Inter Tan for unstable femoral intertrochanteric fracture in elder patients. Methods A total of 111 elder patients with unstable femoral intertrochanteric fracture were randomly divided into DCS group（ n =37）, PFNA group（n =37） and Inter Tan group（n =37） according to treatment methods. The perioperative parameters, healing time, Harris score and complication were assessed. Results There were significant differences among three groups in operation time（F =41.530,P 0.001）, PFNA group was the shortest among three groups, and Inter Tan group was shorter than DCS group. Significant differences were discovered among three groups in blood loss（F =244.890,P 0.001）, PFNA group was the least one, and Inter Tan group was less than DCS group; There were no differences among three groups（χ2=1.631,P =0.442）. There were significant differences among three groups in consolidation time（F =19.765, P 0.001）, but two intramedullary nail groups were shorter score than DCS group（P 0.05）, and there was not different between two intramedullary nail groups（P 0.05）;Significant differences were discovered in Harris score among three groups（F =3.691,P =0.028）, there were no differences between PFNA group and Inter Tan group（P 0.05）, but two intramedullary nail group were higher than DCS group（P 0.05）.The incidences of complications were higher in DCS group than PFNA group and Inter Tan group. Conclusion PFNA and Inter Tan are superior to DCS in complication rates and functional evaluation in treating unstable femoral intertrochanteric fracture, although DCS has the best surgical quality. PFNA fixation has simpler operation and shorter operation time, while Inter Tan fixation has higher anti-rotation stability and lower cut-out rates.