四种手术方式治疗高龄转子间骨折的术后疗效比较

Comparison of four surgical procedures for treatment of elederly femoral intertrochanteric fractures

目的比较四种手术方式治疗高龄转子间骨折的术后治疗效果。方法回顾分析2010年6月至2014年10月来我院行手术治疗的股骨转子间骨折患者。按照动力髋螺钉（DHS组）、股骨近端解剖型锁定加压接骨板（LPFP组）、防旋髓内钉（PF原NA组）和半髋关节置换术（人工关节组）进行分组，分别比较各组手术时间、术中出血量、术后引流量、卧床时间、术中X光暴露次数等围术期参数，对比术后并发症发生率和死亡率，并按照Harris髋关节功能评分系统评价术后各组患髋功能。结果共167例患者纳入研究并获得随访，其中DHS组37例，LPFP组42例，PFNA组53例，人工关节组35例，随访时间12-36个月（平均22.4个月）;围术期参数方面，人工关节组明显优于其他三组（P〈0.05），LPFP组和PFNA组效果相当，且均优于DHS组（P〈0.05）。PFNA组术后并发症发生率和死亡率均低于其他三组（P〈0.05），PFNA组和人工关节组术后关节功能相当，且优于其他两组（P〈0.05）。结论PFNA具有微创操作、出血少，以及固定可靠的优点，而人工关节在临床疗效，以及早期下地负重活动方面的优点更加明显。对于高龄股骨转子间骨折应以PFNA或髋关节置换为首选，DHS、LPFP应谨慎选用。

Objective To compare the clinical efficacy of four different surgical procedures in the treatment of femoral intertrochanteric fractures in elderly patients and provide the basis for treatment.Methods From JUN. 2010 to OCT. 2014,a retrospective study was performed in our institutions. Patients with intertrochanteric fractures were operated by DHS （Dynamic Hip Screw）,LPFP （Locking Proximal Femul Plate）,PFNA （Proximal Femoral Nail Antirotation）, hemiarthroplasty respectively, comparing the operation time, intraoperative blood loss, postoperative flow, bed time, intraoperative X-ray exposure times. Morbidity and mortality of each groups. And Harris hip score system were evaluated postoperative function. Results 167 consecutive patients were followed up with mean period of 22.4 months. 37 patients were undergone with DHS, 42 in LPFP group, 53 in PFNA group, and 35 in hemiarthroplasty. There were statistical significances between hemiarthroplasty and other groups in terms of perioperative parameters （P〈0.05）,and LPFP, PFNA groups were better than DHS （P〈 0.05）.As for morbidity and mortality,PFNA group were superior than other groups （P〈0.05）.There was no significant difference in Harris Hip Score between PFNA and hemiarthroplasty group, but better than LPFP and DHS （P〈0.05）. Conclusion For elderly patients with femoral intertrochanteric fractures, PFNA was superior according to minimally invasive operation, less bleeding and fixed reliable.But hemiarthroplasty in clinical curative effect as well as the early stage of the load activity of the advantages were more obvious. The PFNA and hemiarthroplasty should be considered as the first choice for femoral intertrochanteric fracture in aged patients, LPFP and DHS should be chosen carefully.