不同固定方式修复老年股骨转子间骨折的临床对比研究

Comparison of different fixations for treatment of intertrochanteric fractures in the elderly

目的比较股骨近端解剖锁定钢板(PF-LCP)和股骨近端抗旋髓内钉(PFNA)内固定方式治疗老年股骨转子间骨折的临床效果和并发症发生率。方法将96例老年股骨转子间骨折病人随机分为试验组和对照组,每组各48例。试验组采取股骨近端解剖锁定钢板(PF-LCP)治疗,对照组采取股骨近端抗旋髓内钉(PFNA)治疗。观察2组病人的临床效果和并发症发生率。结果试验组的术中出血量、手术时间、术后引流量均明显少于对照组(P<0.01或P<0.05)。但是2组的骨折愈合时间比较差异无统计学意义(P>0.05)。2组病人的显效率、好转率及总有效率差异没有统计学意义(P>0.05)。试验组的并发症总发生率(6.25%)显著低于对照组(14.58%)(P<0.05)。结论两种内固定方法治疗股骨转子间骨折的临床疗效相当。但PF-LCP手术较PFNA手术出血少、手术时间短、并发症少,是目前老年股骨转子间骨折较为理想的治疗方式。

Objective To compare the clinical effect and incidence of complications of proximal femur anatomic locking plate （PF-LCP） and proximal femoral antirotation intramedullary nail （PFNA） for elderly patients with intertrochanteric fractures. Methods Ninety-six elderly patients with intertrochanteric fractures were randomly divided into treatment group and control group, with forty-eight eases in each group. The patients in the treatment group received PF-LCP treatment, and the patients in the control group received PFNA treatment. The clinical effects and incidence of complications of two groups were observed. Results The operation time, amount of bleeding during operation, and amount of post-operation drainage of the treatment group were significantly less than those of the control group （P〈0. 01, P〈0. 05）. However, the difference in fracture healing time between two groups was not statistically significant （P〉0. 05）. There were no significant differences in effective rate, improvement rate, and total effective rate between two groups （ P〉 0.05 ）. The overall incidence of complications in treatment group （6.25%） was significantly less than that of control group （14.58%） （P〈0. 05）. Conclusions The clinical effect of two internal fixation methods for elderly intertrochanteric fractures is similar. However, compared with PFNA, PF-LCP shows shorter operation time, shorter amount of bleeding during operation, and less incidence of complications, which is an effective alternative to treat elderly intertrochanteric fractures.