不同内固定方案对高龄股骨转子间骨折患者日常生活能力及运动功能的影响

Influence of Different Internal Fixations on the Activities of Daily Living and Motor Function in Elderly Patients with Intertrochanteric Fractures

【目的】比较不同内固定方案对高龄股骨转子间骨折患者日常生活能力及运动功能的影响。【方法】收集2014年3月至2017年2月本院诊治的高龄股骨转子间骨折195例，采用随机数表法分为三组，分别采用股骨近端防旋髓内钉（Proximal Femoral Nail Anti—rotation，PFNA）、动力髋螺钉（Dynamic Hip Screw，DHS）、股骨近端锁定钢板（Locking Proximal Femoral Plate，LPFP）治疗，每组65例。比较三组患者手术情况、恢复情况、并发症发生情况及Barthel指数及运动功能恢复情况。【结果】PFNA组术中出血量、骨折愈合时间少于DHS组、LPFP组，LPFP组术中出血量、手术时间低于DHS组，其骨折愈合时间高于DHS组，组间比较差异有统计学意义（P〈0．05）。PFNA组术后并发症发生率为4．62％，明显低于DHS组的7．69％和DHS组的15．38％，组间比较差异有统计学意义（P〈0．05）。所有患者均获得有效随访，三组患者术后6～12个月Barthel指数均较术前升高，PFNA组术后6～12个月Barthel指数均高于DHS组和LPFP组，组间比较差异有统计学意义（P〈0．05）。术后1年PFNA组临床优良率高于DHS组，DHS组临床优良率高于LPFP组，组间比较差异有统计学意义（P〈0．05）。【结论】较DHS和LPFP而言，PFNA治疗高龄股骨转子间骨折的疗效及安全性最为理想，可有效改善患者日常生活能力、促进运动功能恢复，值得临床推广应用。

[Objective]To compare the effects of different internal fixation schemes on the activities of dai- ly living and motor function in elderly patients with intertrochanteric fractures to provide references for the selection of internal fixations. [Methods] A total of 195 cases of elderly intertrochanteric femoral fractures in our hospital from March 2014 - 2017 February were collected for the study. Patients were divided into three groups： Proximal Femoral Nail Anti-rotation, （PFNA） group, Dynamic Hip Screw （DHS） group, and Locking Proximal Femoral Plate （LPFP）, with 65 cases in each group. The operation, recovery, complications, Barthel index （activities of daily living） and motor function of three groups were compared. The advantages and disadvantages of the three internal fixation schemes were summarized, and the clinical treatment ideas were discussed. [Results] In group PFNA, intraoperative blood loss and fracture healing time were lower than those in group DHS and group LPFP. The amount of bleeding and operative time in the LPFP group were low- er than those in the DHS group, and the fracture healing time in the PFNA group was higher than that in the DHS.group. All these differences between groups were statistically significant （ P 〈0.05）. The incidence of postoperative complications in the PFNA group was 4.62%, which was lower than that in the DHS group （7.69%） and the LPFP group （15.38%）; the differences between groups were statistically significant （ P 〈0.05）.All patients were followed up with for one year. Barthel index at 6 to 12 months after surgery in three groups were higher than that before operation. The Barthel index at 6 to 12 months after surgery was higher in the PFNA group than in the DHS group and LPFP group. The clinical excellent rate of the PFNA group was higher than that of the DHS group at 1 year after surgery. The clinical and excellent rate of the DHS group was higher than that of the LPFP group. The difference between groups was statistically significant （ P 〈0.05）. [Conclusion]The efficacy and safety of PFNA in the treatment of elderly patients with femoral intertrochanteric fractures are the most ideal, and PFNA can also effectively improve the activities of daily living and promote the recovery of motor function. It is worthy of clinical promotion.