髓内外内固定治疗老年人股骨粗隆间骨折的疗效比较

Comparative study of different internal fixation methods for the treatment of senile intertrochanteric fractures

目的对比研究应用Inter TAN股骨近端髓内钉、股骨近端防旋髓内钉(PFNA)和动力髋螺钉(DHS)治疗老年股骨粗隆间骨折的临床疗效。方法回顾性分析2010年5月至2014年12月大连医科大学附属第一医院骨科收治的符合纳入标准的股骨粗隆间骨折患者83例,根据手术方式不同分为Inter TAN组、PFNA组和DHS组,记录三组患者的手术时间、术中出血量,分别于术后3 d及1个月、2个月、3个月、6个月随访并比较三组患者的负重时间、并发症情况及术后Sanders髋关节创伤后功能评分。结果 83例患者均获得随访,随访时间为10~18个月,平均(12.5±1.6)个月。与Inter TAN组和PFNA组相比,DHS组患者手术时间长(88±21)min、出血多(275±105)ml、负重时间长(87±16)d,差异有统计学意义(F=57.171,F=35.252,F=222.413,P<0.01)。DHS组(71.4%)的Sanders评分优良率低于Inter TAN组(93.9%)和PFNA组(93.1%),差异有统计学意义(H=25.217,P<0.01)。DHS组、Inter TAN组和PFNA组并发症发生率分别为6.1%、6.9%、19.0%,差异无统计学意义。结论 PFNA、Inter TAN在治疗老年股骨粗隆间骨折的效果方面明显优于DHS,但是DHS治疗住院期间费用较低。

Objective To compare the therapeutic effect of InterTAN,PFNA and DHS in the treatment of senile femoral intertrochanteric fractures.Methods A retrospective study was performed in83cases of intertrochanteric fractures from May2010to December2014in The First Affiliated Hospital of Dalian Medical University.They were divided into three groups according to different internal fixations:InterTAN group,PFNA group and DHS group.The operation time,intraoperative blood loss,weight bearing time,complications and hip joint function of three groups were recorded at3d and1,2,3,6months postoperatively.Results All83patients were received an average followed-up of12.5±1.6months,range:10-18months.The DHS group sustained longer operation time(88±21min),more blood loss(275±105ml)and longer weight bearing time(87±16d)than the InterTAN group and PFNA group,differences were statistically significant(F=57.171,F=35.252,F=222.413,P<0.01).The excellent and good rate of hip function scores of the InterTAN group and PFNA group were higher(93.9%,93.1%)than that of DHS group(71.4%),differences were statistically significant(H=25.217,P<0.01).Incidence of complications were6.1%、6.9%、19.0%,respectively.Conclusion Compare to DHS,PFNA and InterTAN are more effective methods in senile femoral intertrochanteric fractures,but DHS saves more costs than PFNA and InterTAN.