PFNA与DHS内固定在老年股骨转子间骨折患者中的疗效比较

Comparison of PFNA and DHS in the treatment of elderly patients with intertrochanteric fracture

目的探讨闭合复位微创防旋型股骨近端髓内钉（PFNA）与动力髋螺钉内固定（DHS）对老年股骨转子间骨折治疗效果的影响。方法回顾性分析2010年12月~2013年6月在我院治疗的146例老年股骨转子间骨折患者的病历资料,根据内固定物的不同将其分为PFNA组与DHS组,其中PFNA组74例,DHS组72例。观察两组患者的手术时间、切口引流量、手术出血量、骨折愈合时间、术后并发症发生情况、髋关节功能恢复情况、术后下地时间、日常生活能力评分及Harris评分,采用Rasmussen评分对两组患者术前、术后1个月的运动、触觉情况进行评估。结果纳入研究的病例均完成了2年的随访,PFNA组患者手术时间、手术出血量、下地时间、住院时间、Harris评分优良率优于DHS组,差异有统计学意义（P〈0.05）;两组切口引流量、围术期红蛋白丢失、骨折愈合时间比较,差异无统计学意义（P〉0.05）;治疗1个月后,PFNA组患者运动、触觉评分高于DHS组,差异有统计学意义（P〈0.05）。两组术后均未发生切口感染不愈合、骨折不愈合、下肢静脉血栓形成、髋内翻及内固定松动等情况。结论两种固定方式在术后功能恢复方面差异性不大,但PFNA治疗老年股骨转子间骨折在手术时间、手术出血、下地时间、住院时间、术后并发症方面优势更明显,是临床老年股骨转子间骨折的有效治疗方法。

Objective To explore the therapeutic effect of applying minimally invasive proximal femoral nail antirotation（PFNA） and internal fixation of dynamic hip screw（DHS） in treating intertrochanteric fracture in the elder. Methods From December 2010 to June 2013,146 medical cases of elderly intertrochanteric fracture treated in our hospital were retrospectively analyzed.According to different internal fixations,they were divided into PFNA group（n =74） and DHS group（n =72）.The operation time,incision drainage,surgical bleeding,fracture healing time,occurrence of postoperative complications,recovery of hip function,ambulation time after surgery,activities of daily living score and functional score by Harris standard were observed in the two groups.Rasmussen score was used to compare and evaluate movement and touch one month before and after surgery in the two groups. Results All recruited medical cases were successfully finished 2 years follow-up visits.The indexes of operation time,surgical bleeding,ambulation time after surgery,hospital stay,excellent and good rate of Harris score in PFNA group was better than that in DHS group respectively,with statistical differences（P〈0.05）.There was no statistical difference in incision drainage,hemoglobin loss during perioperative period,or fracture healing time（P〉0.05）.After one-month treatment,indexes of movement and touch score was superior to that in DHS group respectively,with statistical differences（P〈0.05）.After surgery,complications including incision nonunion due to infection,nonunion,deep venous thrombosis,coxa vara,and looseness of internal fixation were not presented in the two groups. Conclusion There was no great difference in postoperative function recovery in these two fixation modes,but PFNA therapy catches opportunities in operation time,surgical bleeding,ambulation time after surgery,hospital stay,and postoperative complications in the treatment of elderly intertrochanteric fractures,which is an effective therapeutic method to treat intertrochanteric fractures in the elder in clinic.