动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折临床疗效比较

Comparison of the effects of dynamic hip screw and proximal femoral nail in treatment of elderly patients with proximal femoral fractures

目的比较动力髋螺钉(DHS)、锁定股骨近端髓内钉(PFNA)治疗老年股骨近端骨折的临床疗效。方法随机数字表格法将符合纳入标准的92例老年股骨近端骨折患者分为A组(50例)与B组(42例),A组患者采取PFNA治疗,B组则行DHS治疗,比较两组手术时间、输血量、术后完全负重时间等指标。平均随访12个月,对两组并发症、随访Harris功能评分、末次随访髋关节功能恢复优良率统计。结果 A组患者平均手术时间、术中失血量、术后显性失血量、术后完全负重时间及骨折愈合时间明显少于B组,隐性失血量明显多于B组,差异有统计学意义(P<0.05)。A组并发症发生率8.00%显著低于B组的28.57%差异有统计学意义(P<0.05)。A组与B组术后1个月、3个月Harris功能评分比较差异有统计学意义(P<0.05),而术后12个月评分比较差异无统计学意义(P>0.05)。末次随访A组髋关节功能恢复优良率92.00%,与B组的80.95%比较差异无统计学意义(P>0.05)。结论 DHS、PFN治疗老年股骨近端骨折术后隐性失血量均较多,1年髋关节功能恢复优良率类似,但相比DHS,PFNA具有创伤小、术后恢复快、并发症少等特点。

Objective To compare the clinical effects of dynamic hip screw （DHS） and proximal femoral nail （PFNA） in the treatment of proximal femoral fractures in elderly patients. Methods 92 elderly patients with proximal femoral fractures were divided into group A （50 cases） and group B （42 cases） by the random number table method. Patients in group A were treated PFNA, while patients in group B were treated with DHS. The operation time, blood transfusion volume and time of full weight bearing were compared between the two groups. The patients were followed up for an average of 12 months. The complications, follow-up Harris function score and the excellent rate of hip function recovery at the last follow-up were statistically analyzed. Results The operation time, intraoperative blood loss, postoperative dominant bleeding volume, postoperative full weight-bearing time and fracture healing time of group A were significantly less than that of group B, while the hidden blood loss of group A was significantly more than that of group B （P〈0. 05）. The incidence rate of complications in group A （8. 00%） was significantly lower than that in group B （28.57 % ） （P〈0.05）. The differences in Harris function scores between the two groups at 1 month and 3 months after operation were significant （P〈0.05）. However, there were no significant differences at 12 months after operation （P〉0.05）. At last follow-up, the excellent rate of hip function recovery in group A was 92.00%. Compared with that in group B （80.95%）, there was no significant difference （P〉0.05）. Conclusion The postoperative hidden blood loss of both DHS and PFN in the treatment of elderly patients with proximal femoral fractures is much. Besides, the 1-year excellent rates of hip function recovery are similar. Compared with DHS, PFNA is with fewer traumas, and patients can recover faster and complications are few.