PFNA与锁定钢板治疗老年股骨粗隆间骨折疗效比较

Comparison of clinical effects of proximal femoral nail anti-rotation and locking plate for intertrochanteric fractures in elders

目的:比较防旋髓内钉(PFNA)与锁定钢板治疗老年股骨粗隆间骨折临床疗效,探讨老年股骨粗隆间骨折理想的手术方式。方法:将92例老年股骨粗隆间骨折患者随机分为两组,每组46例,PFNA组采用PFNA内固定治疗,LCP组采用锁定解剖钢板内固定治疗,比较两组手术时间、术中出血量、术中透视时间,术后对两组随访12个月,比较两组术后负重时间、骨折愈合时间及并发症发生率,并比较两组3个月和12个月时髋关节Harris评分和优良率。结果:两组均成功完成手术,PFNA组手术时间、术中出血量及术后引流量均少于LCP组(P=0.000),两组均获得12个月随访,PFNA组术后负重时间、骨折愈合时间均少于LCP组(P=0.000、0.009);髋关节功能Harris评分及优良率比较:术后3个月PFNA组均高于LCP组,差异有统计学意义(P=0.019、0.001),术后12个月两组比较差异无统计学意义,两组并发症发生率差异无统计学意义。结论:PFNA与锁定钢板内固定均为老年股骨粗隆间骨折有效的治疗手段,但PFNA内固定创伤小、愈合快、并发症少、早期疗效更优,是老年股骨粗隆间骨折理想的手术治疗方式。

Objective： To compare the clinical effects of proximal femoral nail anti-rotation（ PFNA） and locking plate for the treatment of intertrochanteric fractures in elders, to explore the perfect operation method for intertrochanteric fracture elders. Methods： 92 elderly patients with intertrochanteric fracture were randomly divided into two groups,46 cases were in each group,and PFNA group were treated with PFNA internal fixation,and LCP group were treated with locking compression plates（ LCP） fixation,the operation time,amount of bleeding,intraoperative fluoroscopy time were compared and all patients were followed up for 12 months after operation. The weight bearing time,postoperative fracture healing time and the incidence of complications between the two groups were compared,and Harris hip score in 3 and 12 months were compared and the excellent and good rates of the two groups were compared. Results： All patients were successfully completed the operation,the operation time,intraoperative bleeding and postoperative drainage volume in the PFNA group were less than those in LCP group（ P = 0. 000）,two groups were followed up for 12 months,the weight bearing time and the postoperative fracture healing time in the group PFNA were lower than those in the LCP group（ P = 0. 000,0. 009）; Harris hip joint function score and the excellent and good rate were compared： The PFNA group was higher than the LCP group in3 months after operation,the difference was statistically significant（ P = 0. 019,0. 001）,there was no statistically significant difference in 12 months after operation,and there was no statistically significant difference in the incidence rate of complication between the two groups. Conclusion： PFNA and locking plate fixation for intertrochanteric fracture of femur in the elders are the effective treatment means,and the PFNA internal fixation has the advantages of small trauma,quick healing,fewer complications,early curative effect,it is the ideal operation treatment for intertrochanteric fracture of femur in the elders.