髓内及髓外内固定治疗股骨粗隆间骨折的疗效比较

Clinical efficacy of intramedullary versus extramedullary internal fixation in treatment of femoral intertrochanteric fracture

目的比较髓内与髓外内固定治疗股骨粗隆间骨折的临床疗效。方法选取82例股骨粗隆间骨折患者,随机分为研究组与对照组。研究组采用髓外内固定治疗[股骨近端防旋髓内钉(PFNA)],对照组采用髓内内固定治疗[动力髋螺钉(DHS)]。比较2组患者的手术相关指标、不良反应及术后恢复情况。结果研究组术中出血量、手术时间显著少于、短于对照组(P<0.05或P<0.01),而X线透视次数显著多于对照组(P<0.05)。研究组下床负重时间、住院时间显著短于对照组(P<0.05或P<0.01)。术后9个月2组Harris评分比较,差异无统计学意义(P>0.05)。结论股骨粗隆间骨折患者采用髓外内固定手术具有不良反应少、操作简便、手术时间短等优势。

Objective To compare intramedullary and extramedullary internal fixation in treatment of femoral intertrochanteric fracture. Methods A total of 82 patients with femoral intertrochanteric fracture were randomly divided into study group and control group, the study group with 41 patients was given extramedullary internal fixation [proximal femoral intramedullary nail （PFNA）], another 41 cases in the control group were treated by intramedullary internal fixation[intramedullary dynamic hip screw （DHS）], operation related indicators, adverse reactions and postoperative recovery of two groups were compared. Results Intraoperative blood loss, and operative time in the study were less and shorter （ P 〈0.05 or P 〈0.01）, while the X-ray examination times was more than the control group（ P 〈0.05）. The bed-off weight-bearing time and length of stay in the study group were significantly shorter than that in the control group （ P 〈0.05 or P 〈0.01）. There was no significant difference in Harris scores between the two groups at 9 months after operation （ P 〉0.05）. Conclusion Extramedullary internal fixation for patients with intertrochanteric fractures has the advantages of less adverse reactions, simple operation, and short operative time.