不同内固定手术治疗老年股骨粗隆间骨折的疗效对比

Efficacy of different internal fixation in treating elderly intertrochanteric fracture

目的对比不同内固定手术治疗老年股骨粗隆间骨折的疗效。方法回顾性分析2006年1月—2015年12月苏州市立医院北区骨科收治的120例老年股骨粗隆间骨折患者的临床资料,其中21例采取股骨近端锁定解剖钢板(LCP组)固定,49例采取动力髋螺钉(DHS组)内固定,50例采取髓内钉(PFNA组)内固定。比较3组患者的一般手术情况、治疗效果、术后髋关节功能及并发症情况。结果 (1)PFNA组手术时间及术中出血量均明显少于LCP组及DHS组,差异具有统计学意义(P<0.05);(2)PFNA组治疗优良率为90.00%,高于LCP组76.19%及DHS组77.55%,差异有统计学意义(P<0.05);(3)PFNA组Harris评分优良率92.00%,高于LCP组71.43%及DHS组73.47%,差异有统计学意义(P<0.05);(4)PFNA组并发症发生率为6.00%,低于LCP组19.05%及DHS组16.33%,差异有统计学意义(P<0.05)。结论 LCP固定、DHS内固定及PFNA内固定均能有效治疗老年股骨粗隆间骨折,但PFNA内固定手术时间短、术中出血少、并发症发生率低,疗效更优,临床上值得推广。

ObjectiveTo study the efficacy of different internal fixations in treating elderly intertrochanteric fracture.MethodsData of120elderly intertrochanteric fracture patients was retrospectively analyzed,who were treated in our hospital from Jan.2006to Dec.2015among them,21cases were treated with proximal femoral locking compression plate fixation(LCP group);49cases were treated with dynamic hip screw(DHS)internal fixation(DHS group),and50cases were treated with proximal femoral intramedullary nail(PFNA)internal fixation(PFNA group).The operation condition,treatment effect,complications and hip function were compared among three groups.Results(1)The operation time and blood loss in PFNA group were significantly lower than those in LCP group and DHS group,with statistical difference(P<005);(2)The excellent and good rate of PFNA group was9000%,which was higher than those of LCP group(7619%)and DHS group(7755%),with statistical difference(P<005);(3)The excellent and good rate of Harris score in PFNA group was9200%,which was higher than those of LCP group(7143%)and DHS group(7347%),with statistical difference(P<005);(4)The complication rate of PFNA group was600%,which was lower than those of LCP group(1905%)and DHS group(1633%),with statistical difference(P<005).ConclusionLCP fixation,DHS fixation and PFNA fixation are effective treatment methods for elderly intertrochanteric fracture.However,PFNA fixation has shorter operation time,less intraoperative bleeding,lower complication rate and better curative effect.