不同内固定手术治疗老年股骨粗隆间骨折的临床对照研究

Clinical comparative study of different internal fixations in the treatment of intertrochanteric fractures in the elderly

目的比较不同内固定手术在老年股骨粗隆间骨折患者中的应用效果。方法前瞻性选择2013年6月—2016年11月江阴市中医院骨科收治的84例股骨粗隆间骨折患者,按随机数字表法分为两组,各42例,分别采取防旋髓内钉(PFNA)内固定(PFNA组)和动力髋螺钉(DHS)内固定(DHS组)。比较两组手术相关指标与术后3d的血清C反应蛋白(CRP)、白细胞计数(WBC)、皮质醇(Cr)、并发症总发生率、术后1年的髋关节功能优良率。结果 PFNA组手术时间、术中出血量、创口大小、术后引流量、卧床时间分别为(73. 02±9. 85) min、(243. 75±51. 08) m L、(6. 88±1. 22) cm、(61. 33±8. 69) m L、(4. 10±1. 05) d,均显著低于DHS组(P <0. 05)。术后3d,PFNA组血清CRP、WBC与Cr分别为(21. 67±6. 32) mg/L、(9. 20±2. 05)×109/L、(55. 88±10. 87) nmol/L,均低于DHS组术后(P <0. 05)。PFNA组并发症总发生率为7. 14%,显著低于DHS组的23. 81%(P <0. 05)。PFNA组术后1年的髋关节功能优良率为90. 48%,显著高于DHS组的73. 81%(P <0. 05)。结论 PFNA内固定治疗老年股骨粗隆间骨折患者,内固定效果更佳,且创伤应激更轻,安全性高。

Objective To compare the effect of different internal fixation methods in treating elderly patients with intertrochanteric fracture.Methods Totally84patients with intertrochanteric fractures treated in our department were randomly divided into group A and group B and prospectively studied,with42cases in each group.Group A was treated with proximal femoral nail anti-rotation(PFNA)and group B was treated with dynamic hip screw(DHS)internal fixation.The operation related indexes,and serum C reactive protein(CRP),white blood cell(WBC)and cortisol(Cr),total incidence of complications at3d after operation and the excellent and good rate of hip joint function rate at1year after operation were compared between the two groups.Results In group A,the operation time,the amount of bleeding,the size of the wound,the drainage rate and the bed time were(73.02±9.85)min,(243.75±51.08)mL,(6.88±1.22)cm,(61.33±8.69)mL and(4.10±1.05)d,significantly lower than those of the group B(P<0.05).The serum CRP,WBC and Cr in group A at3d after operation were(21.67±6.32)mg/L,(9.20±2.05)×109/L and(55.88±10.87)nmol/L,respectively,which were lower than those in group B after treatment(P<0.05).The total incidence of complications in group A was7.14%,significantly lower than that in group B(23.81%,P<0.05).In group A,the excellent and good rate of hip function at1year after operation was90.48%,significantly higher than that in group B(73.81%,P<0.05).Conclusion PFNA internal fixation for elderly patients with intertrochanteric fractures has better internal fixation,less traumatic stress and good safety.