股骨近端防旋髓内钉和动力髋螺钉内固定治疗老年股骨转子间骨折疗效对比

Clinical efficacy comparison between dynamic hip screw and proximal femoral nail anti-rotation fixation for intertrochanteric fractures in the elderly

目的比较股骨近端防旋髓内钉（PFNA）与动力髋螺钉（DHS）治疗老年转子间骨折的临床疗效。方法对132例老年股骨转子间骨折患者分别采用DHS（60例）和PFNA（72例）治疗,对比两组患者骨折愈合时间等手术指标、髋关节Harris评分及优良率、并发症发生率。结果患者均获得随访,时间12-18（14.29±3.42）个月。PFNA组切口长度、术中出血量、手术时间、引流量、下床负重时间、骨折愈合时间均优于DHS组,差异有统计学意义（P〈0.05）。PFNA组Harris评分（89.37±7.19）分,优40例,良28例,中4例,优良率为94.44%;DHS组Harris评分（81.16±6.54）分,优30例,良21例,中6例,差3例,优良率为85.00%;两组优良率比较差异有统计学意义（P〈0.01）。并发症发生率PFNA组4.17%,DHS组11.67%,两组差异有统计学意义（P〈0.05）。结论 DHS与PFNA治疗老年股骨转子间骨折均有较好的效果,但PFNA更利于术后恢复,且安全性高,临床可考虑优先选用。

Objective To compare clinical effects of dynamic hip screw（ DHS） and proximal femoral nail anti-rotation（ PFNA） fixation for intertrochanteric fractures in the elderly. Methods 132 cases of elderly patients with intertrochanteric fractures were selected,60 cases were treated with DHS,72 cases were treated with PFNA. Harris scores of patients,treatment rate,fracture healing time,complication rate and other clinical indicators were compared between two groups. Results Patients were followed up for 12 - 18（ 14. 29 ± 3. 42） months. In the PFNA group,incision length,blood loss,operative time,drainage,bed time,fracture healing time were better than the DHS group,the differences were statistically significant（ P〈0. 05）. In PFNA group,Harris score was 89. 37 ± 7. 19,the excellent was in 40 cases,good 28,fair 4,excellent-good rate was 94. 44%; in DHS group,Harris scroe was 81. 16 ± 6. 54,the excellent was in 30 cases,good 21,fair 6,poor 3,with the excellent-good rate of 85. 00%; the differences of excellent-good rate between two groups were statistically significant（ P〈0. 01）. PFNA group had complication rate at4. 17%,lower than the DHS group（ 11. 67%）,the difference was statistically significant（ P〈0. 05）. Conclusions DHS and PFNA both provide good effect in treating intertrochanteric fractures,but PFNA is better for postoperative recovery with good safety,which can be clinically preferred.