闭合复位股骨近端防旋钉治疗不稳定型股骨粗隆间骨折的临床效果

Clinical Effect of Closed Reduction and Proximal Femoral Anti-rotation Nail for Unstable Intertrochanteric Fractures of Femur

目的分析闭合复位股骨近端防旋钉治疗不稳定型股骨粗隆间骨折的临床效果。方法 2014年1月—2016年12月,方便选取该院住院部行手术治疗的不稳定型股骨粗隆间骨折患者150例,根据固定方法不同用随机数字法分为3组,A组行闭合复位股骨近端防旋钉(PFNA)治疗,B组用股骨近端锁定加压钢板(LCP)治疗,C组用动力髋螺钉(DHS)治疗。对比3组手术指标,记录术后1、2、3个月人工髋关节疗效量表(Harris)评分;对比3组治疗优良率和并发症发生率。结果与B组和C组比较,A组术中出血量更少,手术时间更短(P=0.000 0;术后3个月A组Harris分值高于B组和C组(P均=0.0000);A组治疗优良率为92.00%,与B组(72.00%)、C组(66.00%)比较,分别为P=0.000 2、P=0.000 0。A组并发症发生率(2.00%)与B组(14.00%)、C组(18.00%)比较,差异有统计学意义(P=0.0018、P=0.000 2)。结论通过与LCP和DHS对比分析,发现PFNA治疗不稳定型股骨粗隆间骨折具有创伤小、愈合快、并发症少、髋关节功能恢复好等优势,值得推广。

Objective This paper tries to analyze the clinical effect of closed reduction and proximal femoral anti-rotation in the treatment of unstable intertrochanteric fractures. Methods 150 patients with unstable intertrochanteric fractures from January 2014 to December 2016 were convenient selected and divided into three groups according to the different fixation methods. The group A adopted closed proximal femoral anti-rotation(PFNA) treatment; group B was treated with femoral proximal locking compression plate(LCP) treatment, and group C was treated with dynamic hip screw(DHS) treatment. The surgical indicators of the three groups were compared, artificial hip effect scale(Harris) score of the operation after1,2,3 months were recorded; treatment rate and the incidence of complications of the three groups were compared. Results Compared with group B and group C, the bleeding volume in group A was the lowest, the operation time was shortest(P=0.0000); Harris score of group A was higher than that of group B and group C at 3 months after operation(P=0.000 0). The excellent and good rate of treatment in group A was 92.00%, compared with group B of 72.00% and group C of 66.00%,The difference was statis tically significant(P=0.000 2,P=0.0000). The incidence of complications in group A was 2.00%, higher than that in group B of 14.00%, group C of 18.00%,The difference was statis tically significant(P =0.001 8, P =0.000 2).Conclusion Compared with LCP and DHS, it was found that PFNA treatment of unstable intertrochanteric fractures had the advantages of fewer traumas, faster healing, fewer complications and good hip function recovery. So it is worth application.