PFNA治疗老年股骨粗隆间骨折临床疗效分析

Evaluation of the clinical curative effects of PFNA and Gamma nail in the treatment of intertrochanteric fractures

目的探讨比较老年股骨近端防旋髓内钉(PFNA)、Gamma钉和股骨近端解剖板(AP)在治疗股骨转子间骨折的临床疗效。方法回顾性分析2010年1月~2012年12月山东大学齐鲁医院骨科行手术治疗的股骨转子间骨折68例患者的临床资料,其中男性29例,女性39例;年龄70~85岁,平均75.7岁。采用PFNA治疗27例,Gamma钉24例,解剖板治疗17例,对三者平均手术时间、术中平均出血量、骨折愈合时间、术后髋关节Harris功能评分、术后并发症进行比较。结果 PFNA组、Gamma钉组、解剖板组三组骨折愈合时间、术后髋关节Harris功能评分、术后并发症无统计学差异;PFNA组与Gamma钉组平均手术时间分别为(63.00±14.00)min、(70.00±16.00)min,无明显差异,但均优于解剖板(91.00±11.00)min;PFNA组术中平均出血量(139.11±24.58)m L,明显少于Gamma钉组(188.38±16.53)m L和解剖板组(233.74±11.06)m L。结论 PFNA、Gamma钉和解剖板三者在治疗股骨转子间骨折均可获得较好的疗效,但PFNA和Gamma钉较解剖板手术时间短,PFNA手术方式较另外两种术中出血量较少。

Objective To evaluate and compare the clinical effects of proximal femoral nail anti-rotation （PFNA） ,Gamma nails and anatomy plate （AP） in treating intertroehanteric fractures. Methods The clinical data of 68 cases of intertrochanteric fractures treated with PFNA or Gamma nails or AP from Jan. 2010 to Dec. 2012 was retrospectively analyzed. Among them 29 were males and 39 were females with an average of 75.7 （ 70-85 } years. Among these patients 27 were treated with PFNA ,24 were treated with Gamma nails and 17 were treated with AP. The mean operative time, blood loss during operation, fracture healing time~ post-operative Harris score and complica- tions were observed. Results There was no significant difference in fracture healing time, Harris score and compli- cations among the three groups,while the PFNA group [ （63.00 ± 14. 00} mini and the Gamma nail group [ （70.00±16.001 min] needed less operative time than the AP group [（91.00± 11.00） mini, and the PFNA group [ （ 139. 11 ±24. 58） mL] had less blood loss during operation than the Gamma nails group [ （ 188. 38 ± 16. 53 ） mL] and the AP group [ （ 233.74 ± 11.06 ） mL ]. Conclusion PFNA, Gamma nail and AP are preferable fixations in trea- ting intertrochanteric fractures, and could achieve ideal clinical outcomes. Compared to AP, PFNA and Gamma nails needed less operative time. Compared to Gamma nails and AP,PFNA had less blood loss during operation.