三种内固定术式治疗股骨粗隆间骨折的疗效比较

A Comparative Study of Three Treatments for Intertrochanteric Fractures

目的比较动力髋螺钉（dynamic hip screw,DHS）、股骨近端髓内钉（proximal femoral nail antirotation,PFNA）、解剖锁定接骨板（locking proximal femoral plate,LPFP）治疗股骨粗隆间骨折的临床疗效。方法回顾性分析2008-01/2012-08月作者医院收治并获得随访的股骨粗隆间骨折患者129例,分别采用DHS（A组,n=36）、PFNA（B组,n=50）、LPFP（C组,n=43）治疗。3组患者术前一般资料比较差异均无统计学意义（P〉0.05）,具有可比性。对3组患者的手术时间、失血量、有限负重时间、骨折愈合时间、颈干角丢失角度及关节功能优良率等进行统计学分析。结果所有患者术后获9~23个月（平均17个月）随访。C组比A、B组手术时间短,出血少,颈干角丢失角度小,差异有统计学意义（P〈0.05）。B组术后有限负重时间比A、C组缩短,差异有统计学意义（P〈0.05）。3组患者在术后关节功能优良率、骨折愈合时间等方面的差异均无统计学意义（P〉0.05）。结论 LPFP治疗股骨粗隆间骨折具有手术操作简单、出血少及术后颈干角丢失角度小等优点,LPFP可允许患者早期有限负重,但对于骨质疏松患者仍有内固定物切出的风险。

Objective To compare the clinical effect of the dynamic hip screw （DHS） , the proximal femoral nail antirotation （PFNA） and the locking proximal femoral plate （LPFP） in treatment of intertrochanteric fractures.Methods From January 2008 to August 2012, 129 patients with intertrochanteric fracture were treated respectively with DHS （group A,n = 36）, PFNA （group B, n = 50） and LPFP （group C, n = 43）. There was no significant difference among three groups in the general data （P〉0.05）.A retrospective study was performed to compare the outcomes of the 3 meth- ods regarding operation time, perioperative blood loss, time for limited weight beating, time for bone union, neck-shaft angle discrepancy and Harris score.Results The follow-up was 9-23 months （average 17 months） .Compared with group A and B, group C showed significant advantages in operative time, blood loss and neck-shaft angle discrepancy （P〈0.05）.Compared with group A and C, group B had significant advantages in time for limited weight beating （P〈0.05） . There were no significant differences in the time for bone union and Harris score.Conclusion The treatment of intertro chanteric fractures with LPFP has many advantages such as simple procedure, low bleeding and less neck-shaft angle dis crepancy.The fracture treated by PFNA allows for earlier weight bearing, but it still run a chance of being cut by internal fixation for patients with severe osteoporosis.