股骨近端外侧锁钉钢板辅助前侧短重建钢板和股骨近端防旋髓内钉治疗老年不稳定股骨粗隆间骨折优劣性对比

The comparison of the advantages and disadvantages of the proximal short lateral fixation plate and PFNA in the treatment of unstable femoral intertrochanteric fractures in the elderly

目的探讨股骨近端外侧锁钉钢板辅助前侧短重建钢板与股骨近端防旋髓内钉(PFNA)两种内固定方式在治疗老年不稳定股骨粗隆骨折的临床疗效及安全性。方法选取我院在2013年5月至2016年4月收治的60例不稳定股骨粗隆间骨折患者,采用前瞻对照研究,按照随机数字表法平均分为试验组和对照组,试验组采用PFNA内固定方式治疗,对照组采用近端外侧锁钉钢板辅助前侧短重建钢板内固定方式治疗;比较2组患者手术指标、术后恢复情况、髋关节Harris评分、髋关节Harris评分优良率及并发症发生率。结果试验组在切口长度、手术时间、术中出血量、术后引流量方面明显优于对照组,差异有统计学意义(P<0.05);试验组骨折愈合时间(90±15)d明显短于对照组(102±14)d、术后开始部分负重时间(20.6±1.8)d明显短于对照组(25.7±1.9)d,比较差异具有统计学意义(P<0.05);试验组术后12个月Harris评分优良率为87%,对照组术后12个月Harris评分优良率63%,比较差异具有统计学意义(χ~2=3.354,P<0.05);2组患者术后1个月、3个月Harris评分比较差异无统计学意义(P>0.05);试验组术后6个月、12个月Harris评分明显高于对照组,差异具有统计学意义(P<0.05);2组患者早期并发症发生率比较差异无统计学意义(χ~2=0.001,P>0.05),试验组晚期并发症发生率为3%,对照组晚期并发症发生率为20%,比较差异具有统计学意义(χ~2=4.043,P<0.05)。结论 PFNA内固定治疗老年不稳定股骨粗隆间骨折疗效显著,手术时间短,晚期并发症少,术后髋关节功能恢复好,值得临床推广。

Objective To investigate the clinical efficacy and safety of two kinds of internal fixation methods for the treatment of unstable femoral trochanteric fractures in the elderly.Methods Sixty patients with unstable intertrochanteric fracture treated in our hospital from May 2013 to April 2016 were selected and prospectively controlled.The patients were equally divided into experimental group and control group according to random number table.PFNA internal fixation was used in the experimental group.The proximal lateral locking plate was used in the control group to assist the anterolateral short reconstruction plate fixation.The surgical indexes,postoperative recovery,hip Harris score and complication rate of the two groups were compared.Results The incision length,operation time,intraoperative blood loss and postoperative drainage volume of the experimental group were significantly better than those of the control group（P〈0.05）.The fracture healing time in the experimental group was significantly shorter than that in the control group[（89.6±15.4）d vs（101.9±13.7）d,（20.6±1.8）d vs（25.7±1.9）d],with significant difference（P〈0.05）.The excellent and good rate of Harris score was 87%at 12 months postoperatively in the trial group,and the excellent and good rate of Harris score was 63%at 12 months postoperatively in the control group.The difference was statistically significant（χ~2=3.354,P〈0.05）.There was no significant difference in Harris score between the two groups at 1 month and 3 months（P〈0.05）.The Harris score at 6 months and 12 months after operation in the experimental group was significantly higher than that in the control group（P〈0.05）.There was no difference in the incidence of early complications between the two groups（χ~2=0.001,P〈0.05）.The incidence of late complications was 3%in the experimental group and 20%in the control group,with significant difference（χ~2=4.043,P〈0.05）.Conclusion PFNA internal fixation is effective in the treatment of unstable intertrochanteric fractures of the elderly.The operation time is short and the complications are few in the late stage.The postoperative hip function is good and worthy of clinical promotion.