两种内固定手术治疗老年股骨转子间骨折的隐性失血量及预后比较

Comparison of hidden blood loss and prognosis between two types of internal fixation in the treatment of intertrochanteric fractures among the elderly

目的 比较动力髋螺钉（dynamic hip screw,DHS）、股骨近端抗旋髓内钉（proximal femoral nail antirotation,PF NA）内固定治疗老年股骨转子间骨折的效果。方法 收集我院骨科收治的68例老年股骨转子间骨折患者,其中DHS内固定治疗32例（DHS组）,PFNA内固定36例（PFNA组）,患者术后均完成1年随访,统计2组患者手术时间、住院时间、术后完全负重时间、骨折愈合时间、隐性失血量,监测髋关节功能变化,比较2组预后。结果 1DHS组总有效率为93.75%,与PFNA组的94.44%对比,差异无统计学意义（P〉0.05）;2PFNA组手术时间、住院时间、术后完全负重时间、骨折愈合时间均短于DHS组（P〈0.05）;3PFNA组术后1、2-3、4-5 d隐性失血量均少于DHS组（P〈0.05）;4术后,2组Harris评分均上升,与术前对比差异有统计学意义（P〈0.05）,PFNA组术后3、6、12个月后评分上升幅度均高于DHS组（P〈0.05）;5术后3、6、12个月PFNA组日常生活活动力表（activies of daihy living,ADL）评分均高于DHS组（P〈0.05）。结论 PFNA内固定术治疗老年股骨转子间骨折,整体效果好,患者隐性失血量少,术后髋关节功能恢复快,预后好。

ObjectiveTo compare the effectiveness of dynamic hip screw （DHS） and proximal femoral nail antirotation （PFNA） in the treatment of intertrochanteric fractures among the elderly.MethodsDate on 68 elderly patients with intertrochanteric fractures who had been treated in the Department of Orthopaedics at our hospital were collected, including 32 cases who had undergone DHS internal fixation （DHS group） and 36 cases who had received PFNA internal fixation （PFNA group）.All the patients completed 1-year follow-up after surgery.The operation time, length of hospital stay, postoperative total weight bearing time, fracture healing time and hidden blood loss in the two groups were statistically analyzed.Changes of hip function were monitored and prognosis was compared between the two groups.Results ①The total effective rate was 93.75% in DHS group and 94.44% （P〉0.05） in PFNA group;②the operation time, length of hospital stay, total weight bearing time and fracture healing time was shorter in PENA group than in DHS group （P〈0.05）;③on postoperative 1, 2-3 d and 4-5 d, the hidden blood loss of PFNA group was less than that of DHS group （P〈0.05）;④after surgery, Harris scores of the two groups were higher than those before surgery （P〈0.05）. The increasing amplitude of scores in PFNA group 3, 6, 12 months after surgery was greater than that in DHS group （P〈0.05）;⑤3, 6, 12 months after surgery, activities of daily living （ADL） scores of PFNA group were higher than those of DHS group （P〈0.05）.ConclusionThe overall effect of PFNA internal fixation in the treatment of intertrochanteric fractures among the elderly is good. The hidden blood loss of patients is little and postoperative hip function recovery is fast, with good prognosis.