不同内固定术式在高龄股骨粗隆间骨折患者的临床应用

Comparison of effect of MIPO and PFNA in treatment of the elderly patients with intertrochanteric fractures

目的对比经皮微创锁定钛板(MIPO)和股骨折端抗旋髓内钉(PFNA)在股骨粗隆间骨折高龄患者中的应用效果。方法选取108例股骨粗隆间骨折高龄患者,根据治疗方式不同分为MIPO组(n=54)和PFNA组(n=54)。对比两组患者的切口长度、手术时间、术中出血量和术后引流量等手术情况,以及两组患者的下地活动时间、骨折愈合时间、术后并发症情况、末次随访的Harries评分及其优良率等术后恢复情况。结果两组患者的手术时间比较,差异无统计学意义(P>0.05)。PFNA组的切口长度、术中出血量、术后引流量、下地活动时间及骨折愈合时间均显著小于MIPO组(P<0.05),而末次随访的Harries评分及优良率均显著大于MIPO组(P<0.05)。MIPO组术后出现4例并发症,均为钛板断裂,患者的骨折分型均为Evans-JensenⅤ型;PFNA组术后出现1例并发症,为下肢深静脉血栓,经过药物治疗后好转。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论与MIPO相比,PFNA在治疗股骨粗隆间骨折的高龄患者中术中出血较少,术后恢复快且效果较好,术后并发症少,值得临床推广。

Objective To compare the effect of minimally invasive plating osteosynthesis （MIPO） and proximal femoral nail-helical blade （PFNA） in treatment of the elderly patients with intertrochanteric fractures. Methods 108 pa- tients with intertrochanteric fractures were divided into MIPO group （n=54） and PFNA group （n： 54）. The incision length, operation time, peri-operative bleeding, postoperative drainage, ambulation time, fracture healing time, postop- erative complications, the last follow-up Harris score and the good rate were compared between two groups. Results There was no significant difference on the operation time between two groups （P〈0.05）. The incision length, peri-oper- ative bleeding, postoperative drainage, ambulation time, fracture healing time of PFNA group were significantly lower than that of MIPO group （P〈0.05）. The follow-up Harris score and the good rate of PFNA group were significantly higher than MIPO group （P〈0.05）. 4 complications in MIPO group were both titanium plate fracture, and the types of intertrochanteric fractures of these patients were both Evans-Jensen V. 1 complication in the PFNA group was lower ex- tremity deep venous thrombosis and improved after drug treatment. There was no significant difference on the incidence of complication between two groups （P〈0.05）. Conclusion Compared with MIPO, PFNA has less peri-operative bleed- ing, faster, better postoperative recovery and less complication in the elderly patients with intertrochanteric fractures.