两种内固定方法治疗老年股骨转子间骨折疗效比较

The clinical effect comparison of two internal fixation methods for treament of the femoral intertrochanteric fracture in the elderly

目的比较股骨近端防旋髓内钉(PFNA)与动态髋螺钉联合转子稳定钢板(DHS+TSP)两种方法治疗不稳定老年股骨转子间骨折的疗效。方法对60例初次接受手术的不稳定老年股骨转子间骨折患者按照随机数字表法分为PFNA组(30例)和DHS+TSP组(30例)。比较两组患者手术相关指标及髋关节功能。结果手术时间、术中出血量、住院时间、负重时间、去拐行走时间PFNA组均明显少于DHS+TSP组,差异均有统计学意义(P<0.01)。患者术后均随访12个月。Harris评分及优良率:术后1个月时DHS+TSP组明显低于PFNA组,差异有统计学意义(P<0.01);术后12个月时两组比较差异无统计学意义(P>0.05)。并发症发生率PFNA组低于DHS+TSP组,差异有统计学意义(P<0.01)。结论 PFNA组比DHS+TSP组减少了手术时间、术中出血量、住院时间、负重时间、去拐行走时间,且短期疗效优于DHS+TSP组。

Objective To compare the effect of proximal femoral nail antirotation （ PFNA） and dynamic hip screw （ DHS）＋trochanter stablizing plate （ TSP） for the elderly femoral intertrochanteric fracture.Methods The instability of femur in the elderly 60 fracture patients undergoing primary surgery ,which were randomly divided into PFNA group and DHS＋TSP group according to digital table ,and 30 cases were in each group.The surgical indexes and hip function of the two groups were compared.Results The operative time , intraoperative bleeding , hospitalization time , weight bearing time and turning to walk time of PFNA group were significantly less than the DHS ＋TSP group,the differences were statistically significant （ P〈0.01 ）;the patients were followed up for 12 months after operation.At postoperative 1 month,DHS＋TSP group for Harris score and excellent-good rate were significantly lower than those in PFNA group, the differences were statistically significant （P〈0.01）,and there were not statistically significant between two groups at 12 months postoperatian（P〉0.05）.The complication incidence rate of the PFNA group was lower the DHS＋TSP group,the difference was statistically significant （P〈0.01）.Conclusions The operation time, blood loss, length of stay, weight bearing time and returning to walk time of PFNA group in the DHS ＋TSP group are decreased, compared with the PFNA group ,the early postoperative recovery of hip function in patients after operation is better.