股骨近端防旋髓内钉与动力髋螺钉内固定手术治疗股骨粗隆间骨折的疗效比较

Comparison of the effect of proximal femoral nail anti-rotation and dynamic hip screw internal fixation in the treatment of intertrochanteric fracture

目的 比较股骨近端防旋髓内钉（PFNA）与动力髋螺钉（DHS）内固定手术治疗股骨粗隆间骨折的临床效果.方法 选取80例患有股骨粗隆间骨折患者为研究对象,采用随机数字表法分为PFNA组和DHS组,每组各40例.比较两组手术时间、术中出血量、术后伤口引流量、术后下地负重时间、愈合时间、并发症发生率、Harris髋关节功能评分情况.结果 PFNA组手术时间低于DHS组（t=22.66,P＜0.05）,术中出血量少于DHS组（t=54.85,P＜0.05）,术后伤口引流量少于DHS组（t=16.85,P＜0.05）,术后下地负重时间短于DHS组（t=20.18,P＜0.05）,愈合时间较DHS组缩短（t=22.00,P＜0.05）.PFNA组Harris髋关节功能评分优良率为95.00％,优于DHS组的80.00％,差异有统计学意义（χ2=4.11,P＜0.05）.PFNA组并发症发生率为7.50％,低于DHS组的25.00％（χ2=4.50,P＜0.05）.结论 相对于DHS,PFNA内固定手术治疗股骨粗隆间骨折具有手术时间少、术中出血量少、愈合时间短、并发症发生率低等优点,临床上值得进一步推广.

Objective To compare the clinical effect of proximal femoral nail anti-rotation（PFNA） and dynamic hip screw（DHS） internal fixation in the treatment of femoral intertrochanteric fracture.Methods 80 patients with femoral intertrochanteric fracture were selected as research subjects.They were divided into PFNA group and DHS group by random number table,40 cases in each group.The operation time,intraoperative blood loss,postoperative wound drainage,postoperative weight-bearing time,healing time,complication rate,Harris hip function score between two groups were compared.Results The operation time of the PFNA group was lower than that of DHS group（t=22.66,P〈0.05）,the amount of bleeding in operation was less than that in the DHS group（t=54.85,P〈0.05）,the postoperative wound drainage volume was less than that of the DHS group（t=16.85,P〈0.05）,the weight-bearing time after operation was shorter than that in the DHS group（t=20.18,P〈0.05）,and the healing time was shorter than that in the DHS group（t=22.00,P〈0.05）.The excellence rate of Harris hip function score in the PFNA group was 95.00%,which was significantly higher than 80.00% in the DHS group,the difference was statistically significant（χ2=4.11,P〈0.05）.The incidence rate of complication of the PFNA group was 7.50%,which was significantly lower than 25.00% of the DHS group（χ2=4.50,P〈0.05）.Conclusion Compared with DHS,PFNA internal fixation has the advantages of less operation time,less intraoperative blood loss,shorter healing time and low complication rate in the treatment of femoral intertrochanteric fracture.It is worthy to be promoted clinically.