不同内固定方式治疗老年股骨转子间骨折的疗效

The effect of different internal fixation methods for the treatment of femoral intertrochanteric fractures in the elderly

目的探讨不同内固定方式治疗老年股骨转子间骨折的临床疗效。方法采用股骨近端解剖型锁定钢板(PFLP)、Gamma钉和股骨近端防旋髓内钉(PFNA)治疗100例老年股骨转子间骨折患者。根据内固定方式不同将患者分为PFLP组(34例)、Gamma钉组(30例)、PFNA组(36例),比较3组手术时间、术中出血量、术后引流量、并发症发生率以及Harris髋关节功能评分。结果患者均获得12个月随访。术中出血量、术后引流量、手术时间3组比较差异均有统计学意义(P<0.001),且各项指标PFNA组优于PFLP组和Gamma钉组(P<0.05),Gamma钉组优于PFLP组(P<0.05)。术后12个月髋关节功能优良率PFNA组明显高于PFLP组和Gamma钉组(P<0.05)。术后并发症发生率3组比较差异无统计学意义(P>0.05)。结论PFLP、Gamma钉及PFNA均可有效治疗老年股骨转子间骨折,髓内固定方式优于髓外固定方式,且采用PFNA治疗的效果更为显著,更利于患者预后。

Objective To explore the clinical efficacy of different internal fixation methods in the treatment of femoral intertrochanteric fractures in the elderly.Methods The 100 elderly patients with femoral intertrochanteric fractures were treated with proximal femoral locking plate(PFLP),Gamma nail and proximal femoral nail anti-rotation(PFNA).According to the different internal fixtion methods,the patients were divided into PFLP group(34 cases),Gamma nail group(30 cases)and PFNA group(36 cases).The operation time,intraoperative blood loss volume,postoperative drainage volume,the incidence rate of postoperative complications and Harris hip function score were compared.Results All patients were followed up for 12 months.There were significant differences in intraoperative blood loss volume,postoperative drainage volume,operation time in the three groups(P<0.001).And the various indicators of the PFNA group were better than the PFLP group and the Gamma nail group(P<0.05),Gamma nail group was significantly better than PFLP group(P<0.05).The hip function excellent-good rate of 12 months after surgery in PFNA group was significantly higher than those in PFLP group and Gamma nail group(P<0.05).There was no significant difference in the incidence rate of postoperative complications among the three groups(P>0.05).Conclusions PFLP,Gamma nail and PFNA are effective in the treatment of intertrochanteric fractures of the elderly,and intramedullary fixation is superior to extramedullary fixation.And the effect of using PFNA treatment is more significant,more conducive to the prognosis of patients.