PFN、DHS、ALP治疗股骨转子间骨折的疗效观察

Clinical Study of PFN, DHS, and ALP in the Treatment of Femoral Intertrochanteric Fractures

【目的】探讨股骨近端髓内钉（PFN）、动力髋螺钉（DHS）及解剖锁定钢板（ALP）治疗股骨转子间骨折患者的临床疗效。【方法】回顾性分析138例股骨转子间骨折患者临床资料，根据其内固定器械使用情况分成PFN组（A组，n=50）、DHS组（B组，n=42）和ALP组（C组，n=46）三组。比对三组患者手术历时、术中失血量、切口直径、骨折愈合时间、患肢负重时间、总住院时间、尖顶距（TAD）值等治疗指标。随访12个月，记录两组患者术前、术后3个月及术后12个月髋关节功能评分（Harris）并比较。【结果】三组患者TAD值比较差异无统计学意义（P〉0．05）；A组患者手术历时、术中失血量、切口直径、骨折愈合时间、惠肢负重时间及总住院时间均显著低于B、C组患者，差异具有统计学意义（P〈0．05）；B组患者切口直径、骨折愈合时间及总住院时间与C组患者比较差异无统计学意义（P〉o．05），而手术历时、术中失血量、患肢负重时间均显著高于C组患者，差异具有统计学意义（P〈0．05）。术前及术后12个月时，三组患者Harris评分及Harris优良率比较差异均无统计学意义（P〉0．05）；术后3个月时，A组患者Harris评分及Harris优良率均明显高于B组患者及c组患者，其差异有统计学意义（P〈0.05）。A组手术并发症发生率为10．0％（5／50），B组为9．5％（4／42），C组为10．9％（5／46），三组间比较差异均无统计学意义（P〉0．05）；三组患者术后均无骨折不愈合、内固定断裂、髋内翻及深静脉血栓等并发症发生。【结论】相对DHS和ALP而言，PFN具有手术历时短、切口小、术中出血量少、恢复期短、并发症发生风险低、预后理想等优势，是治疗股骨转子间骨折的理想治疗方案，值得临床推广。

[Objective]To investigate the differences in clinical application value of proximal femoral nail （PFN）, dynamic hip screw （DHS）, and anatomical locking plate （ALP） in the treatment of femoral intertro- chanteric fracture. [MethodslThe clinical data of 138 cases of patients with femoral intertrochanteric fractures were retrospectively analyzed. According to the use of internal fixation devices, they were divided into three groups： PFN group （group A, n =50）, DHS group （group B, n =42）, and ALP group （Group C, n =46）. The contrast differences in course of operation, volume of intraoperative blood loss, diameter of incision, fracture healing time, weight-bearing time of the diseased limbs, total length of hospital stay, tip apex distance （TAD）, and other treatment indexes were compared among the three groups. With 12 months of follow-up in the period of behaviors, the changes of the results of hip joint function scores （Harris） postoperative 3 months and 12 months were recorded. The difference in incidence of related complications was analyzed. [ResultslThe comparisons of TAD values among patients of the three groups were not statistically significant （ P〉0.05）. The mean course of operation, volume of intraoperative blood loss, diameter of incision, fracture healing time, weight-bearing time of the diseased limbs, and total hospital stay length of patients in group A were significantly lower than those of patients of groups B and C （ P〈0.05）, although there were no significant differences in diameter of incision, fracture healing time, and total length of stay between patients of groups B and C （ P ）〉0.05）. The mean course of operation, volume of intraoperative blood loss, and weight-bearing time of the diseased limbs in patients of group B were significantly higher than those of patients in group C （ P 〈 0.05）. At 12 months before and after operation, the contrast of Harris scores and Harris excellent rates among the three groups were not statistically significant （ P 〉0.05）. Three months after operation, the Harris score and Harris excellent rate of group A were （87.5± 2.8） and 88.0%, respectively, which were significantly higher than scores of （80.2±2.9） and 71.4% of group B and scores of （80.4±3.0） and 69.6% of group C; the differences were statistically significant （ P〈0.05）. The incidence rate of operative complications in group A was 10.0%, 9.5%/00 in group B, and 10.9% in group C. The differences in incidence rates of related surgery complications within the three groups were not statistically significant （P 〉 0.05）. There was no report of fracture disunion, internal fixation fracture, coxa vara, deep vein thrombosis, or other complications in the three groups.[ConclusionlCompared with DHS and ALP, DFN has advantages such as its short course of operation, small incision, less intraoperative blood loss, short period of recovery, low risk of incidence of complications, and better prognosis, which means it is the ideal treatment for femoral intertrochanteric fracture and worthy of clinical promotion.