三种内固定方式治疗老年稳定性股骨粗隆间骨折的疗效对比

Comparison of three internal fixation methods for the treatment of stable intertrochanteric fracture of the femur in the elderly

目的对比分析老年股骨粗隆间骨折Gamma钉、股骨近端防旋髓内钉(PFNA)及动力髋螺钉(DHS)三种内固定治疗的疗效。方法回顾性分析2013年2月—2016年8月南京梅山医院骨科治疗的稳定性股骨粗隆间骨折(Evans-JensenⅠ~Ⅱ型)老年患者(年龄≥65岁,均为单侧骨折)336例,其中接受Gamma钉治疗108例,PFNA治疗137例,DHS治疗91例,观察比较三组患者手术时间、术中出血量、术后引流量、骨折愈合时间等。结果 PFNA组手术时间和术中出血量分别为(68.41±17.64)min和(120.07±32.42)m L,明显低于Gamma钉组和DHS组(P<0.05);Gamma钉组术后引流量为(70.46±29.87)mL,明显低于PFNA组和DHS组(P<0.05);DHS组下地负重时间为(12.10±4.40)周,明显低于Gamma钉组和PFNA组(P<0.05);Gamma钉组下地负重时间为(14.06±4.91)周,明显低于PFNA组(P<0.05);三组骨折愈合时间、术后12个月Harris评分比较差异无统计学意义(P>0.05);DHS组并发症发生率为20.88%,明显高于Gamma钉组和PFNA组(P<0.05)。结论对于老年稳定性股骨粗隆间骨折患者,Gamma钉、PFNA和DHS内固定治疗均可获得满意疗效,PFNA和Gamma钉在缩短手术用时和减少术中出血量效果显著,DHS可使患者早期进行负重训练,临床上应根据患者具体情况进行选择。

Objective To compare the efficacy of Gamma nail,proximal femoral nail anti rotation（ PFNA）and dynamic hip screw（ DHS） in the treatment of intertrochanteric fractures in the elderly. Methods In this study,336 elderly patients with stable intertrochanteric fracture（ type Evans-Jensen Ⅰ to Ⅱ） in the Department of Orthopedics in Nanjing Meishan Hospital from Feb. 2013 to Aug. 2016 were selected,including 108 cases of Gamma nail treatment,137 cases of PFNA treatment,and 91 cases of DHS treatment. The operation time,intraoperative blood loss,postoperative drainage,and fracture healing time were observed and compared. Results The operation time and intraoperative bleeding amount in PFNA group was（ 68. 41 ± 17. 64） min and（ 120. 07 ± 32. 42） m L,respectively,which were significantly lower than those of Gamma nailing group and DHS group（ P 0. 05）. The postoperative flow rate of the Gamma nail group was（ 70. 46 ± 29. 87） m L,which was obviously lower than that of the PFNA group and the DHS group（ P 0. 05）; the weight-bearing time of the DHS group was（ 12. 10 ± 4. 40）weeks,which was lower than the Gamma group and the PFNA group（ P 0. 05）; the weight-bearing time of the Gamma nail group was（ 14. 06 ± 4. 91） weeks,which was obviously lower than that of the PFNA group（ P 0. 05）.The fracture healing time and Harris score at 12 months after operation were not statistically significant among the three groups（ P 0. 05）,and the incidence of the DHS group was 20. 88%,which was significantly higher than that of the Gamma group and the PFNA group（ P 0. 05）. Conclusion For the elderly patients with intertrochanteric fractures,Gamma nail,PFNA and DHS internal fixation can achieve satisfactory results. PFNA and Gamma nails are effective in shortening the operation and reducing the amount of bleeding in operation. DHS can make patients carry out early weight bearing training. The clinical selection should be based on the specific situation of the patients.