两种方法治疗老年股骨转子间骨折的疗效比较

Comparison effect of two methods in the treatment of femoral intertrochanteric fractures in the elderly

目的比较防旋股骨近端髓内钉(PFNA)与股骨转子间顺行髓内钉(InterTAN)治疗老年股骨转子间骨折的临床疗效。方法将141例老年股骨转子间骨折患者根据内固定材料不同分为PFNA组(87例,采用PFNA治疗)和InterTAN组(54例,采用InterTAN治疗)。比较两组患者手术时间、术中出血量、术后输血例数、输血量、骨折愈合时间、内固定相关并发症发生例数、末次随访Harris评分等级、术后下肢深静脉血栓(DVT)发生率。结果手术时间PFNA组短于InterTAN组(P<0.05)。两组术中出血量、术后输血例数和输血量比较差异无统计学意义(P>0.05)。两组患者均获得随访,时间6~18个月。骨折均骨性愈合,骨折愈合时间PFNA组长于InterTAN组(P<0.05)。两组末次随访Harris评分等级、术后下肢DVT发生率及内固定相关并发症发生率比较差异无统计学意义(P>0.05)。结论PFNA与InterTAN均为治疗老年股骨转子间骨折的理想选择,PFNA手术时间更短,而InterTAN术后骨折愈合时间更短。

Objective To compare the clinical effects of proximal femoral nail antirotation(PFNA)and intertrochanteric antegrade nailing(InterTAN)in the treatment of femoral intertrochanteric fractures in the elderly.Methods A total of 141 cases with femoral intertrochanteric fractures in the elderly were divided into two groups,according to the internal fixation materials.The 87 cases received treatment with PFNA and 54 cases received treatment with InterTAN.The operation time,intraoperative blood loss,blood transfusion number and volume,healing time of fracture,complication incidence cases and Harris score grade of patients at the last follow-up,incidence rate of deep vein thrombosis(DVT)in postoperative period were compared between the two groups.Results The operation time in PFNA group was less than that in InterTAN group(P<0.05).There were no significant differences between the two groups in intraoperative blood loss,blood transfusion cases and volume.All patients were followed up for 6~18 months,all cases got bony healing,the healing time of fracture in PFNA group was longer than that in InterTAN group(P<0.05).There were no significant differences between the two groups in Harris score grade of patients at the last follow-up,DVT incidence rate in postoperative period and complication about intramedullary fixation(P>0.05).Conclusions Both PFNA and InterTAN can be used in treatment of femoral intertrochanteric fractures in the elderly.PFNA has advantages of less operation time.However,InterTAN has advantages of shorter healing time of fractures.