两种方法治疗合并糖尿病的老年股骨转子间骨折

Two kinds of methods for treatment of intertrochanteric fracture in the elderly patients with diabetes mellitus

目的比较股骨近端防旋髓内钉(PFNA)与动力髋螺钉(DHS)内固定治疗合并糖尿病的老年股骨转子间骨折的疗效。方法将86例合并糖尿病的老年股骨转子间骨折患者根据治疗方法不同分为PFNA组(采用PFNA治疗,45例)和DHS组(采用DHS治疗,41例)。比较两组切口长度、手术时间、术中出血量、术后引流量、完全负重时间、临床疗效及并发症发生情况。结果患者均获得随访,时间12~16个月。切口长度、手术时间、术中出血量、术后引流量、完全负重时间PFNA组均明显短(少)于DHS组(P<0.05)。并发症发生率PFNA组低于DHS组(P<0.05)。术后3个月Harris评分PFNA组明显高于DHS组(P<0.05);术后6个月、末次随访时Harris评分两组比较差异均无统计学意义(P>0.05);末次随访时Harris评分优良率PFNA组高于DHS组(P<0.05)。结论相比DHS,PFNA治疗合并糖尿病的老年股骨转子间骨折临床疗效更好,更利于关节功能恢复,术后并发症发生率更低。

Objective To compare the efficacy of proximal femoral nail anti-rotation(PFNA)and dynamic hip screw(DHS)in the treatment of elderly intertrochanteric fractures patients with diabetes mellitus.Methods The 86 cases of elderly intertrochanteric fractures with diabetes mellitus were studied.Among them,45 cases who received PFNA treatment were used as PFNA group,and 41 cases received DHS as DHS group.The incision length,operation time,intraoperative bleeding volume,postoperative drainage volume,full weight-bearing time,clinical efficacy and complications were compared between the two groups.Results All cases were followed up for 12~16 months.The incision length,operation time,intraoperative bleeding volume,postoperative drainage volume and full weight-bearing time in PFNA group were significantly shorter(less)than those in DHS group(P<0.05).The total incidence rate of complications in PFNA group was lower than that in DHS group(P<0.05).Harris score in PFNA group was significantly higher than that in DHS group at 3 months after operation(P<0.05).There were no significant differences in Harris score between the two groups at 6 months and the last follow-up(P>0.05).At the last follow-up,the excellent and good rate of Harris score in PFNA group was higher than that in DHS group(P<0.05).Conclusions Compared with DHS,PFNA is more effective in the treatment of elderly intertrochanteric fractures patients with diabetes mellitus,which is more conducive to the recovery of joint function and lower incidence rate of postoperative complications.