股骨近端防旋髓内钉和动力髋螺钉治疗股骨粗隆间骨折的临床对比研究

Comparative study of the PFNA and DHS treatment of intertrochanteric fractures

目的比较股骨近端防旋髓内钉(PFNA)和动力髋螺钉(DHS)治疗股骨粗隆间骨折的临床疗效。方法回顾性分析2008年1月-2014年12月在长沙市第四医院采用DHS(DHS组,60例)和PFNA(PFNA组,64例)内固定治疗股骨粗隆间骨折患者124例,比较两组手术时间、切口长度、出血量、并发症发生率、骨折愈合时间、1年时Harris髋关节功能评分。结果两组手术时间、切口长度、出血量分别为,DHS组:(87±4)min、(14.5±0.6)cm、(150±3)ml;PFNA组:(62±3)min、(7.8±0.4)cm、(100±2)ml,组间比较差异有统计学意义(P<0.05)。PFNA组58例,DHS组53例得到随访,骨折均愈合。平均愈合时间DHS组为(14.2±0.6)周,PFNA组为(12.4±0.4)周,两组比较差异无统计学意义(P>0.05)。DHS组有2例深部血肿,3例复位不满意,2例螺钉切割现象发生,并发症发生率13.2%;PFNA组有1例深部血肿,2例复位不满意,2例骨干劈裂骨折,1例螺钉切割现象,并发症发生率10.3%,两组比较差异无统计学意义(P>0.05)。术后1年Harris评分髋关节功能DHS组优32例,良15例,优良率88.7%;PFNA组优37例,良14例,优良率87.9%。两组比较差异无统计学意义(P>0.05)。结论动力髋螺钉和股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折,都能取得良好疗效,PFNA具有损伤小的优势,PFNA治疗股骨粗隆间骨折更为理想。

Objective To compare and assess the treatment of intertrochanteric fractures by proximal femoral nail antirotation （PFNA） and dynamic hip screw （DHS）. Methods Retrospective analyzed 124 patients of intertrochanteric fractures from January 2008 to December 2014 who were received internal fixation with DHS （DHS group, 60 cases） and PFNA （PFNA group, 64 cases）. The operation time, length of incision, bleeding, the occurrence rate of complications, bony healing times, and Harris hip scores function at 1 year after operation were evaluated and compared. Results The mean operation time, length of incision, bleeding of two groups in DHS group were （87＋4） rain, （14.5±0.6） cm, （150 ± 3） ml, PFNA group： （62 ± 3） min, （7.8±0.4） cm, （100 ± 2） ml respectively. There were significant difference between two groups （P 〈 0.05）. In the study, 58 cases of PFNA group and 53 cases of the DHS group were followed-up, all the fracture healed well. The mean healing time in DHS group in （14.2±0.6） weeks, PFNA group （12.4 ± 0.4） weeks, and there were no significant difference between two groups （P 〉 0.05）. In DHS group, deep hematoma oecun＇ed in 2 cases, the reduction was unsatisfaetory in 3 cases, knifing of screw necun＇ed in 2 cases. The complication occurrence rate was 13.2%. While in PFNA group, there was 1 case with deep hematoma, 2 cases with unsatisfactory reduction, 2 cases with split fracture and 1 case with knifing of screw. The occurrence rate of the complication was 10.3%. There was no significant difference between two groups （P 〉 0.05）. According to one year llarris hip scores, the excellent cases were 32, good cases were 15, the excellent and good rates were 88.7% in DHS group, while in PFNA group, the excellent cases were 37, good cases were 14, the excellent and good rates were 87.9%, there was no significant difference between two groups （P 〉 0.05）. Conclusions The clinical effect is true and perfect in the treatment of intertrochanteric fracture by DHS and PFNA. PFNA has the advantage of less damage, and it is a more effective method for the treatment of intertrochanteric fractures.