两种内固定方式治疗股骨干骨折合并同侧髋部骨折的疗效比较

Effect of two kinds of internal fixation methods in treatment of femoral shaft fracture combined with ipsilateral hip fractures

目的比较股骨近端防旋髓内钉（PFNA）、股骨近端解剖型锁定钢板（ALCP）两种内固定方式治疗股骨干骨折合并同侧髋部骨折的疗效。方法选择2011年1月~2014年1月我院收治的股骨干合并髋部骨折患者60例作为观察对象,将应用股骨近端防旋髓内钉（PFNA）内固定治疗的30例患者设为观察组,其余30例应用股骨近端解剖型锁定钢板（ALCP）内固定治疗的股骨干合并髋部骨折患者设为对照组,比较两组Harris评分术后优良率及两组的手术时间、术中出血量、骨折愈合时间、术后并发症情况,并随访6~12个月,比较两组术后髋关节Harris评分。结果观察组术后1例患髋疼痛,髋关节活动范围变小,走路跛行,其优良率达83.3%（25/30）,对照组术后4例患髋疼痛,髋关节活动范围变小,走路跛行,其优良率70.0%（21/30）,观察组Harris评分术后优良率显著高于对照组（P〈0.05）。观察组的手术时间、股骨干骨折愈合时间均显著少于对照组,且观察组术中出血量也显著少于对照组（P〈0.05）。术后随访6~12个月,末次随访显示,两组患者Harris评分髋关节功能评分比较,差异无统计学意义（P〉0.05）。两组均无感染、深静脉血栓形成、肺栓塞、股骨头缺血性坏死发生。结论股骨近端防旋髓内钉（PFNA）、股骨近端解剖型锁定钢板（ALCP）两种内固定方式均为治疗股骨干骨折合并同侧髋部骨折的有效内固定方法,但PFNA较ALCP内固定具有出血少、并发症少、骨折愈合快等优势,值得推广和应用。

Objective To compare the effect of PFNA and ALCP in treatment of femoral shaft fracture combined with ipsilateral hip fracture. Methods A total of 60 cases with femoral shaft fracture combined with ipsilateral hip fracture from January 2011 to January 2014 were selected as research subjects, among which received application of proximal femoral nail anti rotation （PFNA） of 30 cases as observation group, the remaining 30 cases recieved proximal femur anatomic locking steel plate （ALCP） as the control group, the excellent and good rate, the operation time, the amount of bleeding during operation, the fracture healing time and postoperative complications, postoperative Harris hip scores after following up 6-12 months were compared between two groups. Results One patient in the observation group after operation with hip pain, hip range of motion turned small, walked with a limp, the excellent and good rate was 83.3% （25/30）, the 4 patients of control group with hip pain, hip range of motion turned small, walked with a limp, the excel- lent and good rate was 70.0% （21/30）, the excellent and good rate of Harris after operation in the observation group was significantly higher than that in control group（P〈0.05）. The operation time, femoral shaft fracture healing time and bleeding amount were significantly less than those in the control group（P〈0.05）. The follow-up for 6-12 months, Harris scores of hip joint function score had no significant difference between two groups （P〉0.05）. Conclusion PFNA and ALCP are two kinds of internal fixation methods,which are both the effective methods of internal fixation for the treat- ment of femoral shaft fractures with ipsilateral hip fractures, but PFNA fixation has less bleeding, fewer complications, fast fracture healing and other advantages, is worthy of promotion and application.