髓内及髓外内固定治疗股骨粗隆间骨折的临床效果及生物力学研究

Clinical effect and biomechanical study of intramedullary and intramedullary fixation in the treatment of femoral intertrochanteric fractures

目的 探讨改进型防旋股骨近端髓内钉（PFNA-Ⅱ）与髓外动力髋螺钉（DHS）治疗股骨粗隆间骨折的临床效果及生物力学特点。方法 选取我院骨科2011年9月~2015年9月收治的股骨粗隆间骨折患者60例,采用数字表抽取法随机分组,就采用PFNA-Ⅱ治疗（PFNA-Ⅱ组,n=30）与DHS治疗（DHS组,n=30）效果及切口长度、术中出血量、手术时间、术后并发症发生率展开对比。结果 PFNA-Ⅱ组优良率为96.7%,与DHS组的93.3%比较,差异无统计学意义（P〉0.05）。PFNA-Ⅱ组切口长度、手术时间均短于DHS组,术中出血量少于DHS组,差异有统计学意义（P〈0.05）。PFNA-Ⅱ组仅肺部感染1例,并发症发生率为3.3%;DHS组肺部感染2例,髋内翻1例,并发症发生率为10.0%,组间比较差异无统计学意义（P〉0.05）。结论 PFNA-Ⅱ内固定治疗股骨粗隆间骨折,术中出血少,手术时间短且安全有效,骨质疏松患者更为适合,有较高的推广应用价值。

Objective To investigate the clinical effect and biomeehanical characteristics of the modified proximal femoral nail anti-rotation （PFNA- Ⅱ ） and dynamic hip screw （DHS） in the treatment of femoral intertrochanteric fractures.Methods 60 cases of patients with femoral intertrochanteric fractures who were treated in department of orthopedics in the hospital from September 2011 to September 2015 were selected and divided randomly into two groups ac- cording to the random number table method.The effects,length of incision,amount of intraoperative bleeding,surgicaldu- ratlon,postoperative complicationrate of PFNA- Ⅱ group （treated with PFNA-Ⅱ ,n=30） and DHS group （treated with DHS,n=30） were compared.Results The total effective rate of the femoral intertrochanteric fractures was 96.7%,and there was no difference between PFNA-Ⅱ group and DHS group（93.3%） （P〉0.05）.The length of incision,the amount of intraoperative bleeding and surgicalduration of PFNA- Ⅱ group was less than that of DHS group respectively,with statistical differences （P〈0.05）.Only 1 case of pulmonary infection occurred in PFNA-Ⅱ group, with the comp/icationrate accounting for 3.3% in PFNA- Ⅱ group;two cases of pulmonary infections and 1 case of hip inversion occurred in DHS group,with the complication rate accounting for 10.0%,with no difference between the two groups （P〉0.05）.Conclusion PFNA- Ⅱ demonstrates the advantages of less bleeding,shorter surgical duration,better safety and effectiveness over DHS in the treatment of femoral intertrochanteric fractures,which is more suitable for patients with osteoporosis and deserves greater popularization and application.