股骨近端防旋髓内钉与股骨近端解剖锁定板治疗中老年股骨转子间骨折

Proximal femoral nail anti-rotation and anatomic proximal femoral locking plate in the treatment of intertrochanteric fractures in middle-aged and elderly patients

目的比较股骨近端防旋髓内钉(PFNA)和股骨近端解剖锁定板(APFLP)治疗中老年股骨转子间骨折的疗效。方法将60例中老年股骨转子间骨折患者根据内固定方式不同分为PFNA组(38例)与APFLP组(22例)。比较两组患者的切口长度、手术时间、术中出血量、骨折愈合时间、并发症以及末次随访髋关节Harris评分。结果 PFNA组的切口长度、手术时间、术中出血量均小(少)于APFLP组,差异均有统计学意义(P <0. 05)。60例均获得随访,时间14～25个月。PFNA组出现大腿疼痛1例; APFLP组出现螺钉松动、钢板断裂、创口感染各1例。两组的并发症发生率、髋关节Harris评分及优良率比较差异均无统计学意义(P>0. 05)。结论 PFNA和APFLP治疗中老年股骨转子间骨折均能取得良好的疗效,应根据患者个体情况合理选择。PFNA适应证更广,切口更小,手术时间更短,术中出血量更少。

Objective To compare the clinical efficacy of proximal femoral nail anti-rotation (PFNA) and anatomic proximal femoral locking plate (APFLP) in the treatment of intertrochanteric fractures. Methods The 60 intertrochanteric fractures were treated with surgery,of which 38 cases were treated by PFNA,22 cases were treated by APFLP.The length of incision, operation time, intraoperative bleeding volume, fracture healing time, complication and the hip Harris score in the final follow-up were compared in two groups. Results The incision length,operation time,intraoperative bleeding volume of the PFNA group were less (shorter) than those of the APFLP group,the differences were statistically significant ( P< 0.05). The 60 patients were followed up for 14~25 months.One patient of thigh pain occurred in PFNA group.There was 1 case of screw loosening, plate breakage and wound infection in APFLP group separately.There were no statistically significant differences between the two groups in the complications incidence rate, the hip Harris score and excellent-good rate ( P> 0.05). Conclusions PFNA and APFLP both can obtain good curative effect, reasonable choice should be made according to the individual condition of the patient. The PFNA has the advantages of wider indications, smaller incision length, shorter operation time and less intraoperative bleeding.