PFNA-Ⅱ与DHS治疗老年A2型股骨粗隆外侧壁骨折的临床疗效比较

Therapeutic Effects of the Proximal Femoral Nail Anti-rotation Ⅱ(PFNA-Ⅱ) and Dynamic Hip Screw(DHS)Applied to-A2 Type Lateral Femoral Trochanter Wall Fracture in Elderly Patients

目的对比股骨近端髓内钉-螺旋刀片Ⅱ型(PFNA-Ⅱ)与动力髋螺钉(DHS)应用于老年A2型股骨粗隆外侧壁骨折的临床疗效。方法回顾性分析2011年2月—2014年1月住院治疗的65例老年A2型股骨粗隆外侧壁骨折患者的临床资料,PFNA-Ⅱ治疗35例,DHS治疗30例,比较两组患者手术时间、切口长度、术中总失血量、术中透视次数、术后早期下地活动时间、Harris评分指标。结果 PFNA-Ⅱ组手术时间、切口长度优于DHS组(P<0.01),术后早期下地活动时间明显优于DHS组(P<0.01),但术中透视次数多于DHS组(P<0.01);两组术中总出血量、术后12个月Harris评分比较,差异无统计学意义(P>0.05)。结论 PFNA-Ⅱ治疗老年A2型股骨粗隆外侧壁骨折具有良好的临床疗效,PFNA-Ⅱ组相对DHS组具有骨折愈合快、可早期下地、髋关节功能恢复佳的优点。

Objective To compare the effectiveness of the proximal femoral nail anti-rotation 11 （ PFNA- Ⅱ ） and dynamic hip screw（DHS） in the treatment of A2 type lateral femoral trochanter wall fracture in elderly patients.Methods 65 elderly patients with A2 type lateral femoral tro- chanter wall fracture were treated. Fractures were fixed with PFNA- H in 35 patients （ PFNA-Ⅱ group）, and with DHS in 30 patients （ DHS group） .Follow-up was conducted by telephone fol- low-up, outpatient care, cases review, then compare two groups of surgical operation time, incision length, intraoperative blood loss,time for ambulation, number of perspective, Harris hip score.Results The surgical operation time, incision length and time for ambulation of PFNA- Ⅱ group were significantly less than those of DHS group （P〈0.01）, but the number of perspective of PFNA-Ⅱ group was significantly more than that of DHS group （P〈0.01）.There was no difference in total blood loss and Harris hip score between 2 groups in 12 months after operation （P〉0.05）.Conclusion Both PFNA-H and DHS have good effectiveness in the treatment of A2 type lateral femoral trochanter wall fracture in the elderly patients.By contrast, PFNA-Ⅱ has a high rate of fracture healing,early ambulation, good functional recovery.