外侧壁危险型股骨粗隆间骨折两种内固定比较

Comparison of two types of internal fixation for intertrochanteric fractures with dangerous lateral wall

[目的]对比分析动力體螺钉(dynamic hip screw,DHS)和股骨近端防旋螺钉(proximal femoral nail anti-rotation,PF-NA)治疗外侧壁危险型股骨粗隆间骨折的短期临床疗效。[方法]回顾性分析本院骨科2017年2月-2019年12月收治的外侧壁危险型股骨粗隆间骨折患者68例,依据术前医患沟通结果,将患者分为两组,31例采用DHS内固定,37例采用PFNA内固定。比较两组患者的围手术期、随访和影像资料。[结果]PFNA组在切口长度、手术时间、术中出血量、术中透视时间、住院天数均显著优于DHS组(P<0.05)。所有患者均获得12〜22个月随访,平均(19.31±5.46)个月。PFNA组的术后下地时间、完全负重活动时间均显著早于DHS组(P<0.05)。与术后3个月相比,末次随访时DHS组患者ROM和Harris评分显著增加(P<0.05);而PFNA组两时间点间ROM和Harris评分无显著变化(P>0.05)。术后3个月,PFNA组患髋伸屈ROM及Harris评分均显著优于DHS组(P<0.05);但末次随访时,两组间髋伸屈ROM及Harris评分的差异无统计学意义(P>0.05)。影像方面,两组患者术后骨折复位质量的差异无统计学意义(P>0.05)。术后3个月和末次随访时,PFNA组的颈干角均显著大于DHS组(P<0.05)。两组骨折愈合时间的差异无统计学意义(P>0.05),两组内固定物改变的差异无统计学意义(P>0.05)。[结论]与DHS内固定术相比,PFNA内固定治疗外侧壁不稳定型股骨粗隆间骨折具有更好的临床疗效。

[Objective]To compare the clinical efficacy of dynamic hip screw(DHS)versus proximal femoral nail anti-rotation(PFNA)for femoral intertrochanteric fractures with dangerous lateral wall.[Methods]A retrospective study was done on 68 patients who received surgical treatment for femoral intertrochanteric fractures with dangerous lateral wall in our hospital from February 2017 to December 2019.Based on the consequence of patient-doctor communication,the patients were divided into two groups.Of them,31 patients had DHS used for internal fixation,while the remaining 37 patients had PFNA applied for the fixation.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]The PFNA group proved significantly superior to the DHS group in terms of incision length,operation time,intraoperative blood loss,intraoperative fluoroscopy time,and hospital stay(P<0.05).All patients in both groups were followed up for 12-22 months with a mean of(19.31±5.46)months.The PFNA group resumed walking and full-weight bearing activity significantly earlier than the DHS group(P<0.05).The hip flexion-extension range of motion(ROM)and Harris score significantly increased at the latest follow-up in the DHS group compared with those at 3 months postoperatively(P<0.05),whereas which remained unchanged significantly in the PFNA group between the two time points(P>0.05).The ROM and Harris scores in PFNA group was significantly better than those in the DHS group at 3 months postoperatively,nevertheless which became not statistically significant at the latest follow up between the two groups(P>0.05).Regarding to radiographic assessment,there was no a statistical difference in fracture reduction quality on images between the two groups(P>0.05),however,the PFNA group had significantly greater femoral neck-shaft angle than the DHS group at 3 months and the latest follow up(P<0.05).In addition,there were no significant differences regarding fracture healing time and variations of implant between the two group(P>0.05).[Conclusion]The PFNA is considerably superior to the DHS in term of clinical outcomes for femoral intertrochanteric fractures with dangerous lateral wall.