3种内固定方式治疗老年股骨转子间骨折的疗效比较

The effect comparison of three kinds of internal fixation for treatment of intertrochanteric fractures in elderly patients

目的比较3种内固定方式治疗老年股骨转子间骨折的疗效。方法将109例老年股骨转子间骨折患者按内固定方法不同分为A、B、C 3组。A组(n=31)采用动力髋螺钉(DHS)固定,B组(n=39)采用Gamma钉固定,C组(n=39)采用股骨近端防旋髓内钉(PFNA)固定。比较3组患者手术指标、Harris评分结果、并发症发生情况以及治疗效果。结果手术时间、术中出血量、骨折痊愈时间、下床行走时间A组长(多)于B组和C组,差异均有统计学意义(P <0. 05)。3组患者均获得随访,时间12～18个月。术后12个月时,Harris评分A组明显低于B、C组(P <0. 05),B、C组比较差异无统计学意义(P> 0. 05);并发症发生率A组明显高于B、C组(P <0. 05),B、C组比较差异无统计学意义(P> 0. 05)。治疗效果优良率A组明显低于B、C组(P <0. 05),B、C组比较差异无统计学意义(P> 0. 05)。结论采用3种不同的内固定方式治疗老年股骨转子间骨折,患者均能有效康复,但PFNA和Gamma钉固定效果明显优于DHS。

Objective To compare the efficacy of three kinds of internal fixation in the treatment of elderly femoral intertrochanteric fractures. Methods The 109 elderly patients with femoral intertrochanteric fractures were divided into A, B, and C groups according to their internal fixation methods. Group A （ n =31） was fixed with dynamic hip screw （DHS）, group B （ n =39） was fixed with Gamma nail, and group C （ n =39） was fixed with proximal femoral nail anti-rotation （PFNA）. The operative parameters, Harris score, complications, and treatment effects were compared among the three groups. Results The operative time, intraoperative blood loss, fracture healing time, and time of getting out of bed in group A were longer （more） than those in group B and C. The differences were significant （ P 〈0.05）. All three groups were followed up for 12~18 months. At 12 months postoperation,Harris score in group A was significantly lower than that in group B and C （ P 〈0.05）. There was no significant difference between groups B and C （ P 〉0.05）. The incidence rate of complications was significantly higher in group A than in group B and C （ P 〈0.05）. There was no significant difference between groups B and C （ P 〉0.05）. The excellent-good rate of treatment effect was significantly lower in group A than in group B and C （ P 〈0.05）. There was no significant difference between group B and C （ P 〉0.05）. Conclusions The treatment of femoral intertrochanteric fractures in the elderly is performed by using three different internal fixation methods. All patients are able to recover effectively. However, the PFNA and Gamma nail fixation results are significantly better than those of DHS.