股骨近端抗旋髓内钉与动力髋螺钉对老年不稳定股骨粗隆间骨折疗效的对比研究

Comparative study of proximal femoral nail anti-rotation and dynamic hip screw in the unstable intertrochanteric fractures in the elderly

目的比较股骨近端抗旋髓内钉与动力髋螺钉对老年股骨粗隆间骨折的疗效及并发症情况。方法2011年6月至2014年6月对新疆医科大学第五附属医院收治的158例老年股骨粗隆间骨折患者分别采用动力髋螺钉（DHS组68例）、股骨近端抗旋髓内钉（PFNA组90例）治疗。比较两组患者手术时间、住院天数、负重时间、骨折愈合时间、术中出血量及术后关节功能恢复情况。组间定量资料比较用t检验。应用χ2检验比较两组术后并发症的发生率。结果随访6～18个月（平均12.6个月）。两组在性别、年龄、伤后手术时间及骨折分型等方面差异均无统计学意义（χ^2＝0.025，t＝1.461、1.329，χ^2＝2.070，均P〉0.05）。PFNA组手术时间、术中出血量、住院及负重时间均明显小于DHS组[分别为（47±14）比（114±20） min、（121±26）比（281±44） ml、（10.2±3.3）比（13.5±2.8）d、（29±8）比（53±10） d，t＝8.376、6.669、2.176、2.664，均P〈0.05]；PFNA组术后6个月的Harris评分明显高于DHS组[（90±17）比（87±15）分，t＝2.337，P〈0.05]，但两组的骨折愈合时间差异无统计学意义[（11.8±2.3）比（12.2±2.7）周，t＝1.114，P〉0.05]。DHS组并发症发生率为16.2%，而PFNA组为7.8%，差异有统计学意义（χ^2＝4.801，P〈0.05）。结论DHS适用于身体状况良好、骨折较稳定的老年股骨粗隆间骨折患者，而PFNA固定牢固、损伤小、术后并发症发生率低，适用广泛，在治疗股骨粗隆间骨折中更具优势。

ObjectiveTo compare the effect of proximal femoral nail anti-rotation and dynamic hip screw in treating the femoral intertrochanteric fractures in elderly patients.MethodsFrom June 2011 to June 2014, totally 158 elderly patients of femoral intertrochanteric fracture were treated by surgery, among whom 68 cases were treated with dynamic hip screws （DHS）, and 90 patients were treated with proximal femoral nail anti-rotation （PFNA）. The operative time, hospitalization time, weight-bearing time, fracture-healing time, blood loss and the hip function score after the operation were compared between the two groups by using the t test; and the incidence of the postoperative complication was compared between the two groups by using the Chi square test.ResultsAll the patients were followed-up for 6 to 18 months （12. 6 months on average）. There was no statistic differences in the gender, age, the surgical time after injury and the fracture type between the two groups （χ^2=0.025, t=1.461, 1.329, χ^2=2.070, all P〉0.05）. While, the operative time, blood loss, hospitalization time and the weight-bearing time in the PFNA group were all significantly lower than those in the DHS group[（47±14） vs （114±20） min, （121±26） vs （281±44） ml, （10.2±3.3） vs （13.5±2.8） d, （29±8） vs （53±10） d, t=8.376, 6.669, 2.176, 2.664, all P〈0.05]; and the Harris hip score of 6 months post operation in PFNA group was significantly higher than that in the DHS group （90±17 vs 87±15, t=2.337, P〈0.05）. However, no significant difference in fracture healing time was found between the two groups[（11.8±2.3） vs （12.2±2.7） weeks, t=1.114, P〉0.05]. Moreover, the incidence of complications in the DHS group was 16.2% while it was 7.8% in the PFNA group, the latter was obviously lower （χ^2=4.801, P〈0.05）.ConclusionsDHS is suitable for the patients with good physical condition or for the patients with stable fracture types. While, PFNA has the advantages of firmly fixation, less tissue damage, lower complications and wide indications. So, it is superior in the femoral intertrochanteric fractures.