股骨近端防旋髓内钉与股骨近端锁定解剖钢板治疗老年人股骨粗隆间骨折的疗效比较

Comparison of the effect of PFNA and ALP in the treatment of elder patients with femoral intertrochanteric fracture

目的比较股骨近端防旋髓内钉（PFNA）与股骨近端锁定解剖钢板（ALP）内固定治疗老年人股骨粗隆间骨折的临床疗效。方法回顾性分析霍邱县第二人民医院2011年3月至2017年11月收治老年股骨粗隆间骨折患者52例的临床资料，根据手术方法不同分为采用PFNA内固定治疗26例（PFNA组）和AIjP治疗26例（ALP组）。比较两组患者的手术时间、术中出血量、平均卧床时间及平均骨折愈合时间等临床指标及术后并发症发生情况。结果PFNA组手术时间[（80．1±6．3）min]、术中出血量[（156．2±4.7）mL]、卧床时间[（20．3±2．9）d]、骨折愈合时间[（77．3±3．2）d]显著少于ALP组，差异均有统计学意义（t=21．527、18．879、5．128、17．261，均P〈0．05）；PFNA组Harris评分为（87．30±6．18）分，优良率为92．30％，而ALP组Harris评分为（76．77±4．59）分，优良率为80．77％，两组优良率差异有统计学意义（）（。=0．019，P〈0．05）。观察组并发症发生率为0．00％，明显低于对照组的7．69％（P〈0．05）。结论与ALP比较，PFNA治疗老年人股骨粗隆间骨折疗效显著，固定强度较佳，手术创伤小，骨折愈合迅速，不良反应发生率低。

Objective To compare the clinical effects of PFNA and ALP in the treatment of elder patients with femoral intertrochanteric fracture. Methods The clinical data of 52 elder patients with femoral intertrochanteric fracture in the Second People＇s Hospital of Huoqiu County from March 2011 to November 2017 were retrospectively analyzed. According to the different operation method, the patients were divided into PFNA group （treated with PFNA） and ALP group（treated with ALP）, with 26cases in each group. The operation time, the amount of bleeding, healing time of fracture, postoperative complications, the function of hip joint and incidence of adverse reactions were com- pared between the two groups. Results The operative Time [ （ 80.1 ±6.3 ） min ], intraoperative bleeding [ （ 156.2 ± 4.7 ） mL ], bed time [ （20.3± 2.9 ） d ] and fracture healing time [ （ 77.3 ± 3.2 ） d ] in the PFNA group were significantly lower than those in the ALP group, the differences were statistically significant（ all P 〈 0. 05 ）. The Harris Assessment scores of the PFNA group was （ 87.30 ± 6.18 ） points, the excellent rate of the PFNA group was 92.3%, while the Harris Assessment scores of the ALP group was （76.77 ± 4.59） points, the excellent rate of the ALP group was 80. 77% ,the difference was statistically significant in the excellent rate （ X2 = 0. 019, P 〈 0. 05 ）. The incidence of adverse reactions of the PFNA group was 0. 00%, which was lower than 7.69% of the ALP group （ P 〈 0. 05 ）. Conclusion The proximal femoral intramedullary nail （PFNA） is effective in the treatment of intertrochanteric fracture of the elderly, with better fixation strength, smaller operative trauma, faster fracture healing and lower adverse reaction rate.