股骨近端防旋型髓内钉与动力髋螺钉治疗老年股骨粗隆间骨折的比较

Proximal femoral nail antirotation versus dynamic hip screw in treating senile intertrochanteric fractures

目的比较股骨近端防旋型髓内钉（PFNA）与动力髋螺钉（DHS）治疗老年股骨粗隆间骨折的临床效果。方法回顾性分析2006年2月至2014年12月收治的111例老年股骨粗隆间骨折患者的临床资料。采用PFNA治疗59例，采用DHS治疗52例。观察两组手术时间、术中出血量、术中术后输血量、输血率、部分负重时间、住院时间、术后骨科并发症、骨折愈合时间、再次手术率及髋关节功能。术后髋关节功能按Harris评分进行评定。结果两组间住院时间、骨折愈合时间、术后1年髋关节功能评分、术后骨科并发症及再次手术率比较差异无统计学意义（P〉0．05）。PFNA组手术时间[（60．7±9．9）min]短于DHS组[（97．5±20．5）min]（P〈0．01）；PFNA组术中出血量[（169．2±82．1）ml]少于DHS组[（428．8±126．0）ml]（P〈0．01）；PFNA组人均浓缩红细胞输注量[（0．7±0．9）U]少于DHS组[（1．2±1．3）U]（P=0．028）；PFNA组术中术后输血率（35．6％）低于DHS组（55．8％）（P=0．033）；PFNA组术后部分负重时间[（12．9±10．3）d]早于DHS组[（47．0±15．5）d]（P〈0．01）。结论PFNA操作简单、创伤小、固定牢靠、并发症少，是治疗老年股骨粗隆间骨折的有效方法。

Objective To investigate the clinical effect of proximal femoral nail antirotation （ PFNA） and dynamic hip screw （DHS） in treating senile intertrochanteric fractures. Methods From February 2006 to December 2014,111 cases of senile intertrochanteric fractures treated with PFNA and DHS at our institution were retrospectively analyzed. Fifty - nine cases were treated with PFNA （average age 77.4 years） ; and fifty - two cases were treated with DHS （average age 76. 1 years）. The outcome measures collected for statistical analysis on following aspect： surgical time, blood loss in operation, blood transfused, rate of patients transfused, time to partial weight bearing, hospital stay, healing time of fracture, orthopedic complications, reoperation rate and post-operation hip function. The Harris Hip Score was used for function- al evaluation. Results One hundred and eleven patients were followed up for 10 to 24 months （ average 17.2 months）. There were no significant differences between two groups with regard to the functional outcome at 1 year, hospital stay, orthopedic complications and reoperation rate （ P 〉 0. 05）. There were sig-ificant differences between the PFNA group and DHS group with regard to the surgical time [ （60.7 ± 9.9） rain vs （97.5±20. 5 ）min ], the blood loss in operation [ （169. 2 ± 82. 1 ）ml vs （428. 8 ± 126. 0）ml ], per patient concentrated red blood cells transfused [ （0. 7± 0. 9 ） U vs （ 1.2 ± 1.3 ） U ], blood transfusion rate （35.6% vs 55.8% ） and time to partial weight bearing [ （ 12. 9±10. 3） d vs （47.0 ± 15.5） d] （ P 〈 0. 01 ）. Conclusions PFNA is an effective method for the treatment of senile intertrochanteric fracture with the advantages of simple operative procedure, minimally invasion, stable fixation and fewer complications.