两种微创内固定治疗稳定型股骨转子间骨折比较

Comparison of dynamic hip screw versus proximal femoral nail anti-rotation for treatment of stable femoral intertrochanteric fracture

[目的]分析使用微创动力髋螺钉(dynamic hip screw,DHS)与防旋股骨近端髓内钉(proximal femoral nail anti-rotation,PFNA)内固定治疗稳定型转子间骨折的疗效对比。[方法]回顾分析2011年1月~2015年1月长海医院收治的稳定型转子间骨折患者110例,男38例,女72例,年龄53~76岁,平均63.4岁,分为两组,分别使用微创DHS和PFNA治疗。观察手术切口长度、术中出血量、手术时间、髋部Harris评分、手术失败率、术后疼痛评分及并发症的发生情况。在术后1、3、6、12、18、24个月进行随访,按影像学评定指标及临床疗效指标进行对比分析。[结果]110例获得随访,随访时间10~24个月,平均随访18.8个月。微创DHS和PFNA组手术时间、骨折愈合时间、并发症比较差异无统计学意义(P>0.05)。微创DHS组在切口长度、术中术后出血量、术后疼痛评分、肢体功能恢复优良率方面优于PFNA组,差异有统计学意义(P<0.05)。[结论]微创DHS和PFNA内固定均是稳定型转子间骨折的有效治疗方式。其中,微创DHS内固定具有手术创伤小、术中出血量少,对于软组织保护好等优势,更符合术后快速康复的理念,有助于患者尽早恢复患肢功能,值得推广。

[Objective3 To compare the clinical outcomes of modified minimally invasive dynamic hip screw （DHS） versus proximal femoral nail anti-rotation （PFNA） for treatment of stable femoral intertrochanteric fracture. [Methods] A total of 110 patients with stable intertrochanteric fracture were treated surgically in Changhai Hospital from January 2011 to Jan- uary 2015, including 38 males and 72 females with an average age of 63.4 years old （range 53-76 years） . The patients were randomly divided into the DHS group （n=54） and the PFNA group （n=56） . The incision length, intraoperative bleeding, operation time, operation failure rate, postoperative pain scores and complications were compared between the two groups. Ad- ditionally, the imaging evaluation and the clinical functional assessment were also conducted at 1, 3, 6, 12, 18, 24 months postoperatively. [Results] All patients were followed up for 10 to 24 months with an average of 18.8 months. The operation time, fracture healing time, complications showed no statistically significant differences between the DHS group and PFNA group （P〉0.05） . However, the intra-operative blood loss, postoperative pain score and limb function recovery rate in the DHS group were significantly better than those in the PFNA group, with statistically significant differences （P〈0.05） . [Conclusion] Both minimally invasive DHS and PFNA are effective methods for treatment of stable intertrochanteric fracture. By contrast, the improved DHS has advantages of less surgical trauma, less intra-operative bleeding, as well as better soft tissue protection.