PFNA与PFN内固定治疗老年股骨粗隆间骨折的临床疗效评价

Clinical effect of PFNA and PFN internal fixation in the treatment of elderly patients with femoral intertrochanteric fracture

目的探讨PFNA与PFN内固定治疗老年股骨粗隆间骨折的临床疗效。方法选取2013年2月-2014年6月本院就诊的治老年股骨粗隆间骨折患者75例,所有患者随机分为PFN组37例和PFNA组38例。对两组患者的临床疗效,治疗前后的髋关节功能采用Harris评分,两组的手术时间、出血量、骨折愈合时间、住院时间的情况以及并发症发生率进行比较。结果 PFNA组的总优良率为92.11%,明显高于PFN组的81.08%,两组比较差异具体统计学意义（P〈0.05）。两组患者治疗后Harris髋关节功能评分皆高于治疗前,差异有统计学意义（P〈0.05）;但治疗后两组比较,差异无统计学意义（P〉0.05）。PFNA组的手术时间、术中出血量、骨折愈合时间、住院时间皆明显低于PFN组,差异有统计学意义（均P〈0.05）。PFNA组的并发症发生率为5.26%,明显低于PFN组的13.51%,两组比较差异具有统计学意义（P〈0.05）。结论对老年骨质疏松性股骨粗隆间骨折PFN和PFNA治疗均具有固定牢靠、创伤小、并发症少等优点,但PFNA在缩短手术时间、减少术后并发症方面优于PFN。

Objective To investigate the clinical effect of PFNA and PFN internal fixation in the treatment of elderly patients with femoral intertrochanteric fracture. Methods 75 patients of intertrochanteric fractures in our hospital from 2013 February to 2014 June were selected and randomly divided into a PFN group（with 37 cases） and a PFNA group（with 38 cases）. The clinical efficacy, the function of hip joint before and after the treatment by Harris score, operation time, amount of bleeding, the hospitalization time of the healing time of fracture, hospital stays（incident rate of complications） between the two groups were observed and compared. Results The total excellent and good rate of PFNA group was 92.11%, which significantly higher than that in the PFN group（81.08%）, the difference between the two groups was significant（P〈0.05）. After treatment, the Harris hip function scores of two groups were higher than before treatment（P〈0.05）; The difference of two groups was not significant, after the treatment（P〈0.05）. Operative time, amount of bleeding in PFNA group, fracture healing time, hospitalization time were significantly lower than that in PFN group, the difference was statistically significant（P〈0.05）. The complication rate of PFNA group was 5.26%, significantly lower than the PFN group（13.51%）, the difference between the two groups was significant（P〈0.05）. Conclusion The advantages of firm fixation, little trauma, less complication of PFN and PFNA in elderly osteoporotic intertrochanteric fracture treatment, but PFNA to shorten the operation time and reduce postoperative complications than PFN.