两种内固定治疗股骨粗隆间骨折的比较

Comparison of two internal fixations for femoral intertrochanteric fractures

[目的]比较动力髋螺钉(dynamic hip screw,DHS)和股骨近端抗旋髓内钉(proximal femoral nail antirotation,PF-NA)固定股骨粗隆间骨折的临床效果。[方法]2019年1月-2020年1月,对57例单侧股骨粗隆间骨折患者行手术治疗。其中,27例采用DHS治疗(DHS组),30例采用PFNA治疗(PFNA组)。比较两组临床与影像资料。[结果]PFNA组手术时间、切口长度、术中出血量及住院时间显著优于DHS组(P<0.05);PFNA组的下地行走时间、完全负重活动时间均显著早于DHS组。随时间推移,两组患者VAS评分显著降低(P<0.05),而ROM和Harris评分显著增加(P<0.05)。术后各时间点PFNA组VAS评分、ROM和Harris评分均显著优于DHS组(P<0.05)。术后6个月和末次随访时,PFNA组颈干角显著大于DHS组(P<0.05)。[结论]PFNA及DHS治疗股骨粗隆间骨折均有效,但PFNA临床疗效明显优于DHS。

[Objective]To compare the clinical outcomes of dynamic hip screw(DHS)versus proximal femoral nail anti-rotation(PFNA)for intertrochanteric fractures.[Methods]From January 2019 to January 2020,57 patients underwent surgical treatment for unilateral femoral intertrochanteric fractures.Among them,27 patients received DHS,while the remaining 30 patients had PFNA used for internal fixation.The clinical and radiographic documents were compared between the two groups.[Results]The PFNA group proved significantly superior to the DHS group in terms of operation time,incision length,intraoperative blood loss and hospital stay(P<0.05).In addition,the PF-NA group resumed walking and full weight-bearing activity significantly earlier than the DHS group(P<0.05).The VAS scores decreased significantly(P<0.05),while the Harris scores increased significantly in both groups over time(P<0.05).The PFNA group was significantly better than DHS group in terms of aforesaid scores at each time point after operation(P<0.05).Regarding to radiograph,the PFNA group remained significantly greater neck-shaft angle than the DHS group at 6 months postoperatively and the latest follow-up(P<0.05).[Conclusion]Both PFNA and DHS are effective treatment for femoral intertrochanteric fractures.By comparison,the PFNA is considerably better than the DHS.