DHS、PFNA和人工髋关节置换术治疗股骨粗隆间骨折的疗效对比

Comparison of DHS,PFNA and Hip Prosthetic Replacement Treatment in Femoral Intertrochanteric Fractures

目的比较动力髋部螺钉(DHS)、改良股骨近端防旋髓内钉(PFNA)和人工髋关节置换术在治疗股骨粗隆间骨折时的临床疗效。方法选取2006年9月-2012年5月于江门市人民医院治疗的115例股骨粗隆间骨折患者作为研究对象,将其分为三组,DHS组(39例)、PFNA组(41例)和人工髋关节置换组(35例),对比分析三组的手术情况、术后恢复和并发症。结果DHS组、PFNA组和人工髋关节置换组三者的手术时间、术中出血量、卧床时间和并发症发生率均有显著性差异;一年后三组的Harris评分优良率比较无显著性差异;三组患者一年内VAS疼痛评分无显著性差异;DHS组的并发症发生率为23.1%,PFN A组的为4.9%,人工髋关节置换组的为5.7%。结论三种治疗方法各有利弊,临床中需要通过对患者情况进行综合评估而选择合适的手术方式。

Objective To investigate the different clinical effect of dynamic hip screw（DHS）,modified proximal femoral intramedullary（PFNA）and hip prosthetic replacement treatment in femoral intertrochanteric fractures. Methods 115 elderly patients with femoral intertrochanteric fracture treated in our hospital from September 2006 to May were selected,which were randomly divided into the DHS group（n=39）,the PFNA group（n=41）and the hip prosthetic replacement group（n=35）. The surgery features,clinical effect and postoperative complications were compared among three groups. Results There were significant differences in operation duration,intraoperative blood loss,bed rest time and postoperative complication rate between three groups. There were no significant differences in excellent and good rate of three groups after 12 months. And there were no significant differences in the VAS pain scoring of three groups in 1 months,3 months,6 months and 12 months after operation. The postoperative complication rate in the DHS group was23.1%,4.9% in the PFNA group and 5.7% in the hip prosthetic replacement group. Conclusion There are respective advantages and disadvantages in three treatment methods. It is necessary to make a detailed evaluation for patients to choose an appropriate treatment before operation.