两种内固定术式治疗老年股骨粗隆间骨折疗效观察

Comparison of application effect of MIPO and PFNA in elderly patients of femoral intertrochanteric fracture

目的比较股骨近端抗旋转髓内钉(PFNA)与经皮微创锁定钛板(MIPO)治疗老年股骨粗隆间骨折的疗效。方法将我院50例老年股骨粗隆间骨折分为研究组和对照组,研究组26例采用PFNA治疗,对照组24例采用MIPO治疗,比较两组患者术中、术后情况,术后Harris评分及并发症的发生等。结果两组患者的手术时间差异不大,不具有统计学意义(P>0.05),研究组患者手术后骨折愈合时间、负重时间比对照组短,术中出血量及不良反应发生率明显少于对照组,差异均具有统计学意义(P<0.05);研究组中患者不稳定性骨折优良率高于对照组,差异具有统计学意义(P<0.05),两组患者的稳定性骨折优良率和总优良率差异不具有统计学意义(P>0.05)。结论对于稳定性的股骨粗隆间骨折,PFNA与MIPO疗法均可以选择;对于不稳定型骨折,PFNA稳定性好,固定牢固,不易断裂,优势较MIPO明显。

Objective To compare the curative effect of the proximal femoral nail antirotation （PFNA） and mini- mally invasive plate osteosynthesis （MIPO） in elderly patients of femoral intertrochanteric fracture. Methods 50 patients with femoral intertrochanteric fracture were divided into study group and control group. 26 cases of the study group were treated with PFNA while 24 cases of the control group were treated with MIPO. The incidences of complications during and after operation and postoperative Harris score were compared between two groups. Results Operation time differ- ence between the two groups of patients was not statistically significant （P〈0.05）. The fracture healing time, weight- bearing time, bleeding volume and the incidence of adverse reactions of the study group were significantly smaller than the control group after operation （P〈 0.05）. The excellent and good rate of patients with unstable fracture in study group was higher than the control group （P〈0.05）. There were no significant differences in the excellent and good rate and the total excellent rate of patients with stable fracture between two groups （P〈0.05）. Conclusion For the stable femoral intertrochanteric fracture, PFNA and MIPO treatment all could be chosen. And for unstable fractures, stability of PFNA is good. Its fixation is firm and not easy to be break. The advantage of PFNA is more obvious than that of MIPO.