PFNA与ALP内固定治疗老年股骨粗隆间骨折的临床疗效比较

Comparison of clinical efficacy of PFNA and ALP for treatment of elderly intertrochanteric fractures

目的探讨股骨近端防旋髓内钉（PFNA）与股骨近端解剖型锁定钢板（ALP）2种内固定治疗老年股骨粗隆间骨折的疗效。方法回顾性分析自2010-01—2013-01诊治的71例股骨粗隆间骨折,分为PFNA组和ALP组,分别记录手术切口长度、手术时间、术中出血量、术后失血量、术后下地负重时间、骨折愈合时间以及术后1年的髋关节功能Harris评分等。结果 71例均获得随访12~24（16.8±2.6）个月。在手术切口长度、手术时间、术中出血量、术后失血量、术后负重时间及术后并发症、骨折愈合时间等方面,PFNA组优于ALP组,差异有统计学意义（P〈0.05）;PFNA组随访期间未发现感染、内固定物松动、断裂、股骨头颈切割及髋内翻等与手术相关的并发症,ALP组则出现1例股骨头颈切割、髋内翻2例,2组相比较差异有统计学意义（P〈0.05）。在髋关节功能Harris评分方面,2组比较差异无统计学意义（P〉0.05）。结论PFNA治疗老年股骨粗隆间骨折比ALP具有创伤小、出血少、固定牢靠、骨折愈合时间短等优点。

Objective To explore the effect of proximal femoral nail-rotation（PFNA） and anatomic proximal femoral locking plate（ALP） for unstable intertrochanteric fractures in elderly patients. Methods A retrospective analysis of 71 cases of unstable intertrochanteric fractures from January 2010 to January 2013 was performed, the patients were divided into PFNA group and ALP group. The incision length, operative time, blood loss, postoperative drainage, postoperative ambulation load time, fracture healing time, and from hip function（Harris score） one year after operation were recorded. Results Seventy one patients were followed up for 12 to 24（16.8±2.4）months. In the incision length, operative time, blood loss, postoperative blood loss, postoperative weight-bearing time and postoperative complications, fracture healing time, PFNA group was better than those in ALP group, the differences were statistically significant（P〈0.05）; In PFNA group, there were no infection, implant loosening, fracture, femoral neck and coxa vara and other complications associated with surgery. In ALP group one case had the cutting head and neck, 2 cases had coxa vara, there were significant differences（ P〈0.05）. In hip function（Harris score）recovery between the two groups there was not statistically significant difference（ P〈0.05）. Conclusion PFNA has advantages of less trauma, less bleeding, stable fixation, shorter fracture healing time in treatment of elderly intertrochanteric femoral fractures compared with the ALP.