两种内固定方法治疗老年股骨转子间骨折效果比较

INTERNAL FIXATION IN THE TREATMENT OF INTERTROCHANTERIC FRACTURES IN THE ELDERLY:COMPARISON OF TWO KINDS OF INTERNAL FIXATION

目的比较两种不同内固定方法治疗老年股骨转子间骨折的效果。方法回顾分析2007年1月—2014年12月我院手术治疗的老年股骨转子间骨折病人97例,其中采用动力髋螺钉（DHS）固定37例（DHS组）,股骨近端髓内钉（PFN）固定60例（PFN组）。比较两组的手术时间、术中出血量、术后开始下床活动时间、术后髋关节功能Harris评分及治疗效果。结果 DHS组和PFN组的术中出血量分别为（400±100）、（150±50）mL,手术时间分别为（110±20）、（75±20）min,术后开始下床活动时间分别为（90±15）、（35±5）d,两组比较差异均有统计学意义（t=8.372～21.577,P〈0.01）。两组病人术后3、6、12个月时的Harris评分差异有显著性（t=5.145～10.841,P〈0.05）。随访12～24个月,DHS组、PFN组的优良率分别为70.27%、90.00%,差异有统计学意义（χ2=9.612,P〈0.05）。结论两种内固定方法均为治疗老年股骨转子间骨折的有效方法,PFN手术具有创伤小、失血量少、下床早等优点,疗效优于DHS,适用于各种类型的转子间骨折。

Objective To compare the efficacy of two kinds of internal fixation for intertrochanteric fractures in the elderly. Methods A retrospective analysis was done in 97 elderly with intertrochanteric fractures treated in our hospital during January 2007-December 2014.Of the 97 patients,37underwent dynamic hip screw（DHS）,and 60 received proximal femoral nail（PFN）.Operation time,blood loss at surgery,time of post-operative out-of-bed activity,post-operative Harris score of hip function and the effectiveness were compared between the two methods. Results In the DHS group and PFN group,blood loss was（400±100）mL in DPS and（150±50）mL in PFN,operation time was（110±20）min versus（75±20）min,the time of out-ofbed activity was（90±15）days versus（35±5）days.The differences in the above items between the two methods were significant（t=8.372-21.577,P〈0.01）.The difference in Harris score between the two groups,after 3,6and 12 months after operation,was statistically significant（t=5.145-10.841,P〈0.05）.A follow-up of 12-24 months showed the excellent rates in DHS and PFN groups were 70.27% and 90.00%,respectively（χ2=9.612,P〈0.05）. Conclusion The two internal fixation methodsdynamic hip screw and proximal femoral nail-are both effective for seniors with intertrochanteric fractures,but the latter is superior to the former on the following items：minimally invasive,less blood loss,and early out-of-bed activity,which is suitable for various types of intertrochanteric fractures.