PFNA与DHS内固定治疗股骨粗隆间骨折的比较

Proximal femoral nail antirotation versus dynamic hip screw for intertrochanteric femoral fractures

[目的]探讨股骨近端抗旋髓内钉(PFNA)和动力髋螺钉(DHS)内固定术治疗老年股骨粗隆间骨折的临床效果。[方法]2013年1月~2017年1月,本院收治的股骨粗隆间骨折60例老年患者列入本研究。按照入院顺序数字的偶奇分组,每组30例。偶数者采取PFNA内固定术治疗,奇数者采取DHS内固定术治疗,比较两组围手术期、随访与影像资料。[结果]两组患者均顺利手术,无严重并发症。PFNA组手术时间明显短于DHS组,两组差异有统计学意义[(99.48±35.58)mins vs(143.02±40.74)mins,P<0.05]。PFNA组术中出血量明显少于DHS组,两组差异有统计学意义[(304.45±80.83)ml vs(354.91±90.53)ml,P<0.05]。两组患者均获得随访,随访时间12~20个月,平均(15.44±1.28)个月。PFNA组骨折临床愈合时间明显早于DHS组,差异有统计学意义[(8.69±1.56)周vs(15.44±1.28)周,P<0.05]。PFNA组随访期间并发症发生率显著低于DHS组(3.33%vs 20.00%,P<0.05)。PFNA组患者末次随访时Harris评分明显高于DHS组,差异有统计学意义[(88.85±2.12)分vs(85.67±3.16)分,P<0.05]。[结论]DHS与PFNA内固定术均可有效治疗老年股骨粗隆间骨折,但PFNA效果更优。

[Objective] To compare the clinical outcomes of proximal femoral nail antirotation（PFNA） versus dynamic hip screw（DHS） for femoral intertrochanteric fractures in the elderly. [Methods] From Jan 2013 to Jan 2017, 60 elderly patients with femoral intertrochanteric fractures were included into this study. The patients were divided into two groups based on the serial number, the even number underwent internal fixation with PFNA, while the odd number received internal fixation with DHS with 30 patients in each group. Perioperative and follow-up data were compared between the two groups. [Results] The patients in both group had operation performed smoothly without serious complication. The PFNA group consumed significantly shorter operation time than the DHS group [（99.48±35.58） mins versus（143.02±40.74） mins, P〈0.05], additionally the former had significantly less blood loss than the latter [（304.45±80.83） ml versus（354.91±90.53） ml, P〈0.05]. Regarding to bone healing, the PFNA group proved significantly shortened clinical bone healing time compared with the DHS group [（8.69±1.56） weeks versus（15.44±1.28） weeks, P〈0.05]. Moreover, the PFNA group took significantly less complication incidence than the DHS groups（3.33% versus 20.00%, P〈0.05）. In term of Harris score, the PFNA was also statistically superior to the DHS group at the latest follow up [（88.85±2.12） versus（85.67±3.16）, P〈0.05]. [Conclusion] Both PFNA and DHS are effective to treat femoral intertrochanteric fractures in the elderly, however, the PFNA supply more satisfactory clinical consequences than the DHS.