老年人股骨转子间骨折PFNA和DHS内固定术疗效的临床研究

The clinical study of PFNA and DHS internal fixation for intertrochanteric fracture in the elderly

目的探讨老年人股骨转子间骨折根据解剖学特点分型,选择股骨近端防旋髓内钉(PFNA)和动力髋螺钉(DHS)不同内固定手术治疗的临床疗效。方法 2013年07月至2015年05月根据纳入、排除标准选择股骨转子间骨折老年患者92例,均采用手术治疗,按随机数字表、根据不同的内固定分为PFNA组:44例,DHS组:48例。对两组患者术中术后的变化情况和并发症进行测量记录、比较分析。结果 DHS组的较PFNA组的平均放射时间更短,平均隐性出血量更少,而PFNA组的较DHS组的平均术中出血量更少。两组患者的平均手术时间、住院时间、开始下床活动时间、骨折愈合时间和髋关节功能Harris评分比较差异无统计学意义(P>0.05)。两组患者的并发症中如泌尿系感染、肺部感染、压疮、下肢深静脉血栓(DVD)、近端螺钉头颈部切割及髋内翻的发生率比较差异无统计学意义(P>0.05);而近端螺钉退钉、髋外侧或大腿部疼痛的发生率比较差异有统计学意义(P<0.05)。结论老年人股骨转子间骨折根据骨折的分型选择PFNA或DHS内固定手术治疗,各有优缺点,但只要达到有效的固定后进行早期功能锻炼,能减少并发症,患侧髋关节活动功能均能恢复良好。

Objective To investigate the clinical effects of proximal femoral nail antirotation（PFNA） and dynamic hip screw（DHS） internal fixation in the treatment of intertrochanteric fracture in the elderly according to the anatomical features of type. Methods From July 2013 to May 2015 the 92 cases of elderly patients with femoral intertrochanteric fracture were selected according to inclusion and exclusion criteria, all were treated by surgical treatment. According to the random number table and the different internal fixation they were divided into a PFNA group（44 cases）, and a DHS group（48 cases）. The changes and complications of the two groups were recorded and compared. Results The average radiation time was shorter and the occult blood loss less in the DHS group than in the PFNA group, while the average blood loss in PFNA group was less than that in the DHS group. There was no significant difference in the average operation time, length of stay, time of beginning getting out of bed and do movement, the time of fracture healing and the function of the hip joint function in the two groups（P〈0.05）. The incidence of complications such as urinary tract infection, pulmonary infection, bedsore, deep venous thrombosis of lower limb（DVD）,proximal screw head and neck incision, and coxavara rate difference was not statistically significant in two groups（P〈0.05）; The incidence of proximal screw withdrawal, pain in the lateral hip or thigh was statistically significant（P〈0.05）. Conclusions PFNA or DHS internal fixation, each with its own advantages and disadvantages, should be selected according to fracture type of intertrochanteric fracture in the elderly.However, as long as effective fixation was achieved, early exercise can reduce complications, and the hip function in the affected side can recover well.