PFNA与锁定钢板治疗股骨近端和粗隆间骨折效果比较

Therapeutic Effect of PFNA and Locking Plate Fixation in the Treatment of Proximal Femoral and Intertrochanteric Fractures

目的:比较PFNA与锁定钢板治疗股骨近端和粗隆间骨折的效果。方法:选择2013年10月-2016年1月笔者所在医院收治的股骨近端与粗隆间骨折患者120例,信封法随机分为髓内钉-螺旋刀片组(PFNA组)与锁定钢板内固定组(内固定组),各60例。术后72 h,观察两组患者血红蛋白、红细胞压积、手术输血量、隐性失血量、术后48 h引流量、输血发生率,比较两组患者手术时间、切口长度、负重时间、住院时间、骨折愈合。采用Harris评分比较两组患者髋关节功能评分,超声检查患肢静脉血栓、肺部感染及褥疮发生情况。结果:手术前后,PFNA组平均血红蛋白、红细胞压积组内比较差异均无统计学意义(P>0.05),内固定组平均血红蛋白、红细胞压积组内比较,差异均有统计学意义(P<0.05)。PFNA组与内固定组手术输血量、隐性失血量、术后48 h引流量、输血发生率明显降低,差异均有统计学意义(P<0.05)。PFNA组手术时间、切口长度、住院时间、骨折愈合时间较内固定组明显缩短,负重时间延长,差异均有统计学意义(P<0.05)。两组患者术后髋关节功能评分比较,差异无统计学意义(P>0.05)。PFNA组与内固定组比较,术后下肢静脉血栓形成率、肺部感染率、脑血栓形成及褥疮发生率明显减少,差异均有统计学意义(P<0.05)。结论:髓内钉-螺旋刀片钉系统与锁定钢板内固定治疗股骨近端和粗隆间骨折对髋关节功能影响相当,但PFNA内固定方式具有微创、损伤小、术后愈合快、术中及术后临床不良反应少等特点,临床疗效优于锁定钢板内固定治疗,值得临床推广应用。

Objective：To analyze the effectiveness of proximal femoral nail anti-rotation（PFNA） and locking plate in the treatment of proximal femoral and intertrochanteric fractures.Method：From October 2013 to January 2016,120 cases of patients with proximal femoral and intertrochanteric fractures were randomly divided into proximal femoral nail anti-rotation group（PFNA group） and locking plate internal fixation group （internal fixation group） according to the envelope method,sixty cases in each group.Seventy-two hours after operation,the levels of hemoglobin,red blood cell pressure product,operative blood transfusion,hidden blood loss,postoperative 48 h drainage,the incidence of transfusion were observed of two groups and the operation time,incision length,load time,the length of time,fracture healing of two grouos were compared. The hip joint function score of patitents of two groups were compared by Harris hip score,the incidence rate of limb venous thrombosis by ultrasonography,pulmonary infection rate and incidence of pressure ulcers of two groups were compared.Result：Before and after surgery,the levels of average hemoglobin,red blood cell pressure product within PFNA group had no statistical significance differences（P〉0.05）.But the average hemoglobin, red blood cell pressure treatment product were compared,the differences within in internal fixation group groups had statistical significance（P〈0.05）.The amount of blood transfusion,blood loss,postoperative 48 h drainage volume,blood transfusion incidence rate of two groups decreased significantly,there were significant difference （P〈0.05）.The operation time,incision length,hospitalization time,healing time were significantly shortened in PFNA group,weight-bearing time prolonged more than internal fixation group,there were significant differences （P〈0.05）.There was no statistical significance in postoperative hip function score of two groups（P〉0.05）. Comparison two groups,the postoperative venous thrombosis incidence rate of lower formation,pulmonary infection,cerebral thrombus formation and pressure ulcers significantly reduced,the differences of two groups had statistical significance（P〈0.05）.Conclusion：The proximal femoral nail anti-rotation and locking plate fixation of proximal femur and trochanter fracture of hip joint function have a equivalent effect.But PFNA internal fixation has some advantages of minimally invasive,less injury,faster postoperative healing characteristics and intraoperative and postoperative clinical adverse reactions,the clinical curative effect of PFNA internal fixation is better than locking plate fixation,it is worthy of clinical application.