PFNA与股骨近端锁定钢板治疗老年股骨转子间不稳定骨折的效果对比观察

Comparative observation of the effect of PFNA and PELP in the treatment of unstable intertrochanteric fractures in the elderly

目的:对比分析PELP(股骨近端锁定钢板)、PFNA(股骨近端防旋髓内钉)治疗老年股骨转子间不稳定骨折的效果。方法:选取2018年2月~2020年2月收治的116例股骨转子间不稳定骨折老年患者分为A组和B组,A组给予PFNA治疗,B组给予PELP治疗,比较两组临床指标、恢复指标、术后各时间点Harris评分及髋关节功能恢复情况、并发症发生情况。结果:A组患者手术时间、术中出血量及切口长度指标均优于B组(P<0.05);术后引流量、术后负重时间、骨折愈合时间、住院时间较B组均显著降低(P<0.05)。术前及术后12个月两组髋关节功能评分无显著性差异(P>0.05),术后3、6个月A组患者髋关节功能评分显著高于B组(P<0.05);术后6个月A组患者髋关节功能恢复优良率较B组显著提高(P<0.05),术后12个月两组患者髋关节功能恢复优良率无显著性差异(P>0.05);A组患者术后并发症发生率为5.17%,较B组的18.97%显著降低(P<0.05)。结论:与PELP相比,PFNA治疗股骨转子间不稳定骨折老年患者远期疗效相当,均能够促进患者髋关节功能的恢复,但是PFNA治疗该疾病可缩短手术时间,减轻手术对患者的创伤,减少术后并发症发生率,及早负重训练,提高近期临床疗效,值得推广。

Objective:To compare and analyze the effects of PELP(proximal femoral locking plate)and PFNA(proximal femoral anti-rotation intramedullary nail)in the treatment of unstable intertrochanteric fractures of the elderly.Methods:116 elderly patients admitted from February 2018 to February 2020 with unstable femoral intertrochanteric fractures were divided into group A and B.Group A was treated with PFNA and group B was treated with PELP.The clinical indicators,recovery indicators,Harris scores and hip joint function recovery status at each postoperative time point and complications were compared between the two groups.Results:The operation time,intraoperative blood loss and incision length indicators of group A were better than those of group B(P<0.05);the postoperative drainage,postoperative weight bearing time,fracture healing time and hospitalization time were significantly lower than those of group B(P<0.05).There was no significant difference in hip function scores between the two groups before and 12 months after surgery(P>0.05).The hip function score of patients 3 and 6 months after surgery in group A was significantly higher than that of group B(P<0.05),and the excellent and good rate of hip joint function recovery of patients in group A was 94.83%higher than that in group B at 6 months after surgery(P<0.05).At 12 months after surgery,there was no significant difference in the excellent and good rate of functional recovery of the hip joints of both groups(P>0.05).The postoperative complication rate of group A was 5.17%,which was significantly lower than 18.97%of group B(P<0.05).Conclusion:Compared with PELP,PFNA in the treatment of unstable femoral intertrochanteric fractures in elderly patients has the same long-term curative effect and can promote the recovery of hip joint function.However,PFNA treatment can shorten the operation time,reduce the trauma of the operation to the patient,reduce the incidence of postoperative complications,promote early weight-bearing training,and improve the short-term clinical effect.It is worth promoting.