动力髋螺钉和股骨近端防旋型髓内钉治疗老年股骨粗隆间骨折的临床效果比较

Comparison of Clinical Efficacy of Dynamic Hip Screw and Proximal Femoral Nail Anti-Rotation in the Treatment of Elderly Patients with Intertrochanteric Femur Fracture

目的:观察比较老年股骨粗隆间骨折患者采用动力髋螺钉(DHS)、股骨近端防旋髓内钉(PFNA)治疗的临床效果。方法:选取2017年5月-2019年7月本院收治的80例老年股骨粗隆间骨折患者,根据治疗方式分为DHS组与PFNA组,每组40例。比较两组手术时间、术中出血量、住院时间、术后负重时间、术后并发症发生情况,术前及术后2周、2个月、6个月髋关节功能评分(Harris)。结果:PFNA组术中出血量、手术时间、住院时间及术后负重时间均少于DHS组,差异均有统计学意义(t=35.4527、28.7841、4.5324、9.4534,P<0.05)。DHS组术后并发症发生率为20.00%,高于PFNA组的2.50%,差异有统计学意义(χ2=6.1346,P=0.0133)。术前,两组Harris评分比较,差异无统计学意义(P>0.05)。术后2周、2个月、6个月,两组Harris评分均高于术前(P<0.05),且PFNA组均高于DHS组,差异均有统计学意义(t=3.2937、3.3485、5.8497,P=0.0007、0.0006、0.0000)。结论:在老年股骨粗隆间骨折患者中,DHS虽为最早期采取的目前广泛使用于临床的手术方案,但PFNA治疗具有更短的手术操作时间、更少的术中出血量、更好的稳固固定度,可较早完成术后负重活动,较早进行髋关节功能锻炼,有效减少术后并发症,效果理想。

Objective:To observe the clinical efficacy of dynamic hip screw(DHS)and proximal femoral nail anti-rotation(PFNA)in elderly patients with intertrochanteric femur fracture.Method:A total of 80 elderly patients with intertrochanteric femur fracture admitted to our hospital from May 2017 to July 2019 were selected,they were divided into DHS group and PFNA group according to the treatment method,40 cases in each group.The surgery time,intraoperative blood loss,total length of hospital stay,postoperative weight-bearing time,incidence of postoperative complications were compared between the two groups,and hip function score(Harris)were compared between two groups before surgery and 2 weeks,2 months and 6 months after surgery.Result:The intraoperative blood loss,surgery time,total length of hospital stay and postoperative weight-bearing time of PFNA group were lower than those of DHS group,and the differences were statistically significant(t=35.4527,28.7841,4.5324,9.4534,P<0.05).The incidence of postoperative complications of DHS group was 20.00%,it was higher than 2.50%of PFNA group,the difference was statistically significant(χ2=6.1346,P=0.0133).Before surgery,there was no significant difference in hip function score(Harris)between two groups(P>0.05).2 weeks,2 and 6 months after surgery,hip function scores(Harris)of two groups were higher than those of before surgery(P<0.05),and PFNA group were higher than those of DHS group,the differences were statistically significant(t=3.2937,3.3485,5.8497,P=0.0007,0.0006,0.0000).Conclusion:Although DHS is the earliest surgical procedure for elderly patients with intertrochanteric femur fracture,PFNA has the advantages of shorter operative time,less intraoperative bleeding,better fixation,early postoperative weight bearing and early hip functional forging,it is effective to reduce postoperative complications effectively.