三种固定方式治疗老年转子间骨折疗效对比分析

Comparison of three fixation methods in the treatment of intertrochanteric fractures in the elderly

目的探讨采用动力髋螺钉(DHS)、股骨近端锁定加压钢板(PFLP)及股骨近端防旋髓内钉(PFNA)治疗老年转子间骨折的临床疗效,为临床选择治疗方式提供依据。方法选取2005-01-01-2018-01-01大连大学附属中山医院采用多种内固定方式手术治疗的152例老年转子间骨折患者为研究对象。根据组间基本特征匹配的原则,选择其中采用DHS治疗的41例患者为DHS组,PFLP治疗的54例患者为PFLP组,PFNA治疗的57例患者为PFNA组。通过随访观察其愈合情况,并对髋关节术后功能进行评分比较。结果患者均获随访,平均随访时间为(23.8±4.2)个月。在手术切口长度(F=49.718,P<0.001)、手术用时(F=2545.283,P<0.001)、术中出血量(F=8086.141,P<0.001)、负重开始时间(F=2020.064,P<0.001)及骨折愈合时间(F=66.979,P<0.001)方面,PFNA组均优于DHS组和PFLP组,差异有统计学意义。术后患髋Harris评分优良率,PFNA组为87.7%,PFLP组为87.0%,DHS组为56.1%,PFNA组和PFLP组高于DHS组,χ^(2)=17.097,P=0.009。结论对于病情复杂、不能耐受长时间手术的转子间骨折老年患者,建议优先选用PFNA系统,小切口基础上备选PFLP系统;对患有严重骨质疏松症或存在PFNA禁忌证的老年骨折患者,建议选用PFLP系统。

Objective This paper intended to explore the clinical efficacy of dynamic hip screw(DHS),proximal femoral lock plate(PFLP)and proximal femoral nail anti-rotation(PFNA)in the treatment of intertrochanteric fractures in the elderly,so as to provide a basis for clinical selection.Methods A retrospective analysis was conducted on the clinical efficacy of 152 elderly patients with intertrochanteric fracture treated by various internal fixation methods in our hospital from January 1,2005 to January 31,2016,including 41 patients in the dynamic hip screw group,54 patients in the proximal femoral locking compression plate group,and 57 patients in the proximal femoral anti-rotation intramedullary nail group.The healing was observed through follow-up,and the postoperative function of the hip joint was scored and compared.Results All patients were followed up with an average of(23.8±4.2)months.Length of surgical incision(F=49.718,P<0.001),operation time(F=2545.283,P<0.001),intraoperative blood loss(F=8086.141,P<0.001),weightbearing start time(F=2020.064,P<0.001)and fracture healing time(F=66.979,P<0.001),the PFNA group were better than the DHS group and PFLP group,the difference was statistically significant.The postoperative hip Harris score excellent rate was 87.7%in the PFNA group,87.0%in the PFLP group,and 56.1%in the DHS group.The difference of excellent rate of Harris score between the groups was statistically significant(χ^(2)=17.097,P=0.009).Conclusions For the elderly patients with intertrochanteric fracture who have complicated medical conditions and cannot tolerate long-term surgery,it is recommended to choose the PFNA system as the first choice,and choose the alternative PFLP system based on the small incision.PFLP system is recommended for elderly fracture patients with severe osteoporosis or contraindications to PFNA.