股骨近端抗旋髓内钉和动力髋螺钉治疗股骨转子间骨折对患者术后隐性失血及预后影响的对比观察

Effect of proximal femoral anti-rotation versus dynamic hip screw on postoperative hidden blood loss and prognosis in the treatment of femoral intertrochanteric fractures

目的比较股骨近端抗旋髓内钉(PFNA)和动力髋螺钉(DHS)治疗股骨转子间骨折对患者术后隐性失血情况及预后的影响。方法回顾性分析2016年7月至2020年7月于山西医科大学第二医院行PFNA术或DHS术的114例股骨转子间骨折患者的临床资料,根据手术方式分为PFNA组(60例)和DHS组(54例)。比较两组围术期实际出血量、隐性出血量,记录并比较两组术前及术后3 d的凝血功能[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)]水平,比较两组术后3个月髋关节恢复情况(股骨颈干角、Harris评分)及术后3个月内的并发症发生情况。结果PFNA组实际出血量、隐性出血量为(833.62±87.16)、(575.26±76.95)ml,均多于DHS组的(685.73±92.58)、(311.85±81.27)ml(P均<0.05);PFNA组显性出血量为(258.36±62.06)ml,少于DHS组的(373.88±57.68)ml(P<0.05)。术后3 d,两组APTT、PT水平与术前比较差异均未见统计学意义,且组间比较差异亦未见统计学意义(P均>0.05)。术后3个月,PFNA组Harris量表中功能评分高于DHS组(P<0.05),但两组患者股骨颈干角及Harris量表疼痛、畸形、关节活动度评分比较差异均未见统计学意义(P均>0.05)。结论两种内固定术后股骨转子间骨折患者均存在隐性失血,且PFNA术后隐性出血量更多,但髋部功能恢复情况优于DHS组,因此临床上需根据患者实际情况选择内固定方式。

Objective To compare the effects of proximal femoral anti-rotation(PFNA)and dynamic hip screw(DHS)on postoperative hidden blood loss and prognosis in patients with femoral intertrochanteric fractures.Methods The clinical data of 114 patients with femoral intertrochanteric fractures who underwent PFNA surgery or DHS surgery in the Second Hospital of Shanxi Medical University were retrospectively analyzed.According to the operation modes,patients were divided into the PFNA group(60 cases)and the DHS group(54 cases).The perioperative actual blood loss and hidden blood loss were compared between the two groups;the levels of coagulation function,including activated partial thromboplastin time(APTT)and prothrombin time(PT)before and 3 days after operation were recorded and compared between the two groups.The hip recovery(femoral neck shaft angle,Harris score)of the two groups were compared 3 months after surgery,and the incidences of complications were compared between the two groups within 3 months after surgery.Results The actual blood loss and hidden blood loss of PFNA group were(833.62±87.16)and(575.26±76.95)ml,respectively,higher than the(685.73±92.58)and(311.85±81.27)ml of DHS group(all P<0.05).The obvious blood loss in PFNA group was(258.36±62.06)ml,which was less than the(373.88±57.68)ml in DHS group(P<0.05).There were no significant differences in intra-group comparison on APTT and PT levels in the two groups,and there was no significant difference between the two groups 3 d after surgery(all P>0.05).The function score of Harris scale in PFNA group was higher than that in DHS group 3 months after surgery(P<0.05),and there was no statistical difference in the femoral neck shaft angle and scores of pain,deformity and joint range of motion of Harris scale between the two groups 3 months after surgery(all P>0.05).Conclusions Patients with femoral intertrochanteric fractures after the two kinds of internal fixation may have hidden blood loss,and patients after PFNA has more obvious blood loss,but its hip function recovery is better,compared with those of DHS.Therefore,it is necessary to choose the internal fixation method according to the actual situation of patients in clinical practice.