股骨近端防旋髓内钉及动力髋螺钉治疗老年骨质疏松粗隆间骨折疗效分析

Comparison of the effect of proximal femoral nail anti-rotation and dynamic hip screws in intertrochanteric fracture in elderly patients with osteoporosis

目的比较股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)和动力髋螺钉(dynamic hip screw,DHS)治疗老年骨质疏松患者合并粗隆间骨折的临床疗效。方法选取2011年12月—2014年12月患有骨质疏松合并粗隆间骨折老年患者共72例,根据手术所选内固定的不同分为PFNA组(38例)和DHS组(34例)。对手术时间、术中失血量、术后负重时间、术后髋关节Harris评分等指标进行组间对比分析。结果所有患者均获随访,随访时间5~24个月(平均13.5个月)。PFNA组手术时间[(40.25±24.23)min]短于DHS组[(72.65±34.65)min],术中失血量[(136±56)m L]低于DHS组[(256±102)m L],术后负重时间[(5.24±4.52)d]早于DHS组[(15.69±6.78)d],术后髋关节Harris评分[(80.23±10.26分)]高于DHS组[(54.75±12.37分)],差异均有统计学意义(P<0.05)。结论对于老年骨质疏松伴有粗隆间骨折患者,采用PFNA治疗手术时间短,创伤小,髋关节功能恢复优于DHS治疗,术后可使患者早期负重,从而提高生活质量。

Objective To compare the effect of proximal femoral nail anti-rotation （PFNA） and dynamic hip screw （DHS） in the treatment of intertrochanteric fracture in elderly patients with osteoporosis. Methods A total of 72 elderly patients with intertrochanteric fractures were enrolled between December 2011 and December 2014. According to the different surgical methods, the patients were divided into PFNA group （38 cases） and DHS group （34 cases）. The operation time, perioperative blood loss, postoperative weight-bearing time, Harris score were compared between the two groups. Results All cases were followed up for 5-24 months （mean, 13.5 months）. The operation time in PFNA group was shorter than that in DHS group [（40.25＋24.23） vs. （72.65＋34.65） minutes], the perioperative blood loss in PFNA group was less than that in DHS group [（136±56） vs. （256±102） mL], the postoperative weight-bearing time in PFNA group was earlier than that in DHS group [（5.24±4.52） vs. （15.69±6.78） days], and the Harris score in PFNA group was higher than that in DHS group （80.23±10.26 vs. 54.75±12.37） ; the differences above were all statistically significant （P〈0.05）. Conclusion Elderly patients with intertrochanteric fracture and osteoporosis treated with PFNA have shorter operation time, less wounds, better hip function, and earlier weight-bearing than the patients treated with DHS; the surgical method can improve the patient life quality.