防旋股骨近端髓内钉在治疗老年股骨转子间骨折中的应用

Application of Proximal Femoral Nail Antirotation in the treatment of elderly patients with instability fractures intertrochanteric

目的探讨防旋股骨近端髓内钉在治疗老年股骨转子间骨折中的应用价值。方法选取2014年7月～2015年6月笔者所在单位60例高龄股骨转子间骨折的患者临床资料进行回顾性分析，根据患者手术方法不同，将其分为观察组与对照组，每组30例。观察组行PFNA内固定治疗，对照组行动力髋螺钉内固定（DHS）治疗。观察两组患者手术时间、术中出血量及术后下床活动时间，并术后3个月、术后6个月、术后12个月对患者髋关节功能评估。结果观察组手术时间、术中出血量分别为（46．8±6．45）min、（110．8±10．5）mL，明显少于对照组（138．4±17．8）min、（442．3±24．1）mL，差异有统计学意义（埔间=8．173，P〈0．05；t出血量=4．841，P〈0．05）。观察组与对照组的平均下床活动时间分别为（15．94±8．87）d、（40．03±10．69）d，观察组明显少于对照组，差异有统计学意义（t=3．942，P〈0．05）。两组患者髋关节功能Harris评分均随着随访时间的延长而均较前一时间点明显提高，且观察组髋关节功能Harris评分在同一时间点也明显高于对照组。所有患者的骨折均一期愈合。观察组术后并发症发生率明显低于对照组，差异具有统计学意义（X^2=5．624，P〈0．05）。结论防旋股骨近端髓内钉在治疗老年股骨转子间骨折，具有手术损伤小，出血少，术后功能恢复快等特点，是一种有效的治疗方法，值得推广使用。

Objective to investigate the value of Proximal Femoral Nail Antirotation in the treatment of elderly patients with instability fractures intertrochanteric. Methods 60 patients with intertrochanteric fractures were selected and analyzed retrospectively from July 2014 to June 2015. According to different surgical methods, patients were divided into observation group and control group, 30 cases in each group. The observation group was given PFNA internal fixation, while the control group was given action hip screw fixation （DHS）. The operative time, intraoperative blood loss and postoperative ambulation time of two groups were observed, and the hip function was assessed after operation for 3 months, after operation for 6 months and after surgery for 12 months. Results the operative time and bleeding volume of the observe group were（46.8 ± 6.45） min and（110.8 ± 10.5）ml, significantly less than that of the control group （138.4 ± 17.8）min, （442.3± 24.1）, significant difference was statistically significant （t1=8.173, P 〈 0.05; t2=4.841, P 〈 0.05）. The average ambulation time of the observation group and the control group was （15.94 ± 8.87）d,（40.03 ± 10.69） d, the observation group was significantly less than the control group, with statistical difference （t=3.942,P 〈 0.05）. Harris score of two groups were compared with the previous point in time as the follow-up time extend significantly improved, and the observe group of hip function Harris score was significantly higher than the control group at the same point in time. The incidence of postoperative complications in the observation group was significantly lower than that in the control group, with statistical difference（X^22=5.624, P 〈 0.05）. Conclusion Proximal Femoral Nail Antirotation in the treatment of elderly patients with instability fractures intertrochanteric has the advantages of less operation injury, less bleeding and faster postoperative recovery. It is an effective treatment method, which is worthy of popularization.