PFNA与Gamma钉治疗老年骨质疏松患者股骨粗隆间骨折的疗效评价

The Therapeutic Assessment of Proximal Femoral Nail Antirotation and Gamma Nail on Intertrochanteric Fracture of Femur in Elderly Osteoporosis Patients

目的比较股骨近端防旋髓内钉(PFNA)与Gamma钉治疗老年骨质疏松患者股骨粗隆间骨折的临床疗效。方法 89例老年股骨粗隆间骨折患者,46例使用PFNA固定,43例使用Gamma钉固定,比较两种术式平均手术时间、术中出血量、术后引流量、术中X线曝光时间、住院时间、骨折愈合时间以及术后功能恢复情况。结果 PFNA组在平均手术时间、术中出血量、术后引流量、术中X线曝光时间,均低于Gamma钉组,差异有统计学意义(P<0.01);住院时间、骨折愈合时间两组比较差异无统计学意义(P>0.05)。按Harris功能评分PFNA组和Gamma组优良率分别为91.34%和89.96%,差异无统计学意义(P>0.05)。结论 PFNA内固定坚强,微创操作,手术时间短,出血少,允许早期功能锻炼,是治疗老年股骨粗隆间骨折的理想方法,尤其适用于骨质疏松的老年不稳定股骨粗隆间骨折。

Objective To compare the curative effects of proximal femoral nail anti - rotation（PFNA） and Gamma Nail for treating Intertrochanteric Fracture of Femur in elderly osteoporosis patients. Methods All of eighty- nine patients with intertrochanteric fractures in elderly patients were reviewed. Forty- six patients were treated with PFNA, Forty - three patients were treated with Gamma Nail. The difference between these two methods , including mean operation time, intraoperative bleeding, drainage volume of blood, X - ray expo- sure time, hospital stay time, time of bone union and hip function grade were recorded and compared. Results Mean operation time intraoperative bleeding, drainage volume of blood, X - ray exposure time in PFNA opera- tion is less than Gamma Nail operation, the differences were statistically of significant（P 〈 0.01 ）. But there were no obvious differences in length of incision, hospital stay time , time of bone union（P 〉 0.05 ）. Evaluate Harris hip scores, the percentage of good hip function after operation was 91.34 % （PFNA） and 89.96 % （Gam- ma Nail）, and the differences were no significant in both groups（P 〉0.05）. Conclusion PFNA has advantages of strong Iternal Fixation, little damage, reduction of operation time and bleeding, early activity, so it can be recommended to treat intertrochanteric fractures in the elderly osteoporosis patients because of satisfactory effect and high quality of life after the operation.